BackgroundThis study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia.MethodsSeventy-seven patient, aged 2–12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded.ResultsDexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D.ConclusionBoth tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration.Trial registrationRetrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016

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Background: In anesthesia practices, the prevention of sympathetic discharge is important. Dexmedetomidine is a sedative with anxiolytic and analgesic effects. However, its effects on hemodynamic response in direct laryngoscopy are not clear. Objectives: This study aimed to compare the effects of dexmedetomidine with well-known premedication agent midazolam. Methods: Intramuscular 0.05mgkg-1 midazolam (GroupM) or intravenous 1 gkg-1 dexmedetomidine (GroupD) was applied to cases who were scheduled for direct laryngoscopy under general anesthesia. Heart Rate and mean arterial pressure (MAP) were measured before premedication and noted down as control values. Preoperative hemodynamic parameters, recovery times and sedation levels of both groups were compared. Results: In the comparison of MAP of the groups at the postintubation 1 st and 5 th min, the values of Group M were significantly higher (p=0.04, p=0.002). Mean postintubation MAP values at the 1 st , 5 th , and 10 th min and mean postextubation MAP values, at the 1 st min of GroupM were significantly higher than the mean control MAP (p=0.001, p=0.003, p=0.008, p=0.002, p=0.008 respectively). Conclusion: Dexmedetomidine premedication is a more effective alternative to midazolam premedication for hemodynamic stabilization and early recovery in direct laryngoscopy operation.

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