Intravenous dexmedetomidine pre-medication reduces the required minimum alveolar concentration of sevoflurane for smooth tracheal extubation in anesthetized children: a randomized clinical trial

Abstract

BackgroundIt has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal extubation (MACEX) in anesthetized children.MethodsA total of seventy-five pediatric patients, aged 3–7 years, ASA physical status I and II, and undergoing tonsillectomy were randomized to receive intravenous saline (Group D0), dexmedetomidine 1 μg∙kg−1 (Group D1), or dexmedetomidine 2 μg∙kg−1 (Group D2) approximately 10 min before anesthesia start. Sevoflurane was used for anesthesia induction and anesthesia maintenance. At the end of surgery, the initial concentration of sevoflurane for smooth tracheal extubation was determined according to the modified Dixon’s “up-and-down” method. The starting sevoflurane for the first patient was 1.5% in Group D0, 1.0% in Group D1, and 0.8% in Group D2, with subsequent 0.1% up or down in next patient based on whether smooth extubation had been achieved or not in current patient. The endotreacheal tube was removed after the predetermined concentration had been maintained constant for ten minutes. All responses (“smooth” or “not smooth”) to tracheal extubation and respiratory complications were assessed.ResultsMACEX values of sevoflurane in Group D2 (0.51 ± 0.13%) was significantly lower than in Group D1 (0.83 ± 0.10%; P < 0.001), the latter being significantly lower than in Group D0 (1.40 ± 0.12%; P < 0.001). EC95 values of sevoflurane were 0.83%, 1.07%, and 1.73% in Group D2, Group D1, and Group D0, respectively. No patient in the current study had laryngospasm.ConclusionDexmedetomidine decreased the required MACEX values of sevoflurane to achieve smooth extubation in a dose-dependent manner. Intravenous dexmedetomidine 1 μg∙kg−1 and 2 μg∙kg−1 pre-medication decreased MACEX by 41% and 64%, respectively.Trial registrationChinese Clinical Trial Registry (ChiCTR): ChiCTR-IOD-17011601, date of registration: 09 Jun 2017, retrospectively registered.

Ultrasonic Image Restoration Algorithm for Prevention of Nervous Disorders during the Recovery Period of Patients Receiving Sevoflurane Anesthesia

“…e incidence of ADE in the experimental group was significantly lower than that in the control group (P < 0.05). is was similar to the results of Di et al [19], suggesting that Dex can reduce the incidence of emergency agitation and ADE in children. In addition, the hemodynamic indicators of two groups were analyzed at different time points, and the results showed that the patient can maintain a good hemodynamic level during the operation.…”

Dexmedetomidine Ameliorates Hippocampus Injury and Cognitive Dysfunction Induced by Hepatic Ischemia/Reperfusion by Activating SIRT3-Mediated Mitophagy and Inhibiting Activation of the NLRP3 Inflammasome in Young Rats

“…Dexmedetomidine (Dex) is a type of general anesthetic, widely used in children and infants [ 35 , 36 ]. Numerous studies have elucidated its anti-inflammatory, antiapoptotic, and neuroprotective effects [ 37 ].…”

The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section

“…Dexmedetomidine is a centrally acting a 2 -adrenergic agonist with a short half-life (2–3 h vs. 12–24 h for clonidine, another classic α 2 -adrenergic agonist). Because of its potentially beneficial physiologic effects, dexmedetomidine is widely used for sedation in mechanical ventilation, procedural sedation, prevention of acute agitation, and neuroprotection [22–27]. Dexmedetomidine may exert its anti-shivering effects by acting on the central thermoregulatory system and reducing vasoconstriction and the shivering threshold [28].…”