A prospective randomized controlled double-blind trial to assess the effects of dexmedetomidine during cleft palate surgery

Abstract

BackgroundWe investigated whether the intraoperative administration of dexmedetomidine would attenuate the profound sympathoadrenal response associated with cleft palate (CP) surgery.MethodsSixty children aged 6 months to 12 years undergoing CP surgery under general anesthesia were randomly assigned to the control (C) or dexmedetomidine (D) groups. Group C received benzodiazepine (0.05 mg/kg midazolam followed by infusion of normal saline) fentanyl isoflurane anesthesia, and Group D received dexmedetomidine (loading 1 µg/kg followed by infusion of 0.5 µg/kg/h) fentanyl isoflurane anesthesia. Heart rate (HR), mean blood pressure (MBP), intraoperative fentanyl and isoflurane requirements, recovery scores, emergence agitation, pain scores, time and requirement of rescue analgesic, and surgeon satisfaction were noted.ResultsIntraoperative HR and MBP in Group D were significantly lower than the corresponding values in Group C (P < 0.001). HR decreased up to 16% in Group D. By contrast, HR increased up to 20% in Group C. Group D had comparable MBP to its baseline, whereas Group C had higher MBP until extubation (P = 0.015). Two children in Group D developed bradycardia and hypotension, which was successfully treated. The fentanyl and isoflurane requirements decreased by 43% and 30%, respectively, in Group D patients compared to those in Group C (P < 0.001). Group D had lower pain scores and less emergence agitation (P < 0.001). Time until requirement of first rescue analgesic was longer in Group D than that in Group C (P < 0.001). Surgeon satisfaction was higher in Group D than that in Group C.ConclusionsIntravenous dexmedetomidine during CP surgery attenuated hemodynamic responses with excellent surgeon satisfaction. Close monitoring of hemodynamics is recommended.

Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

“…Moreover, we could not extract data from two studies. Finally, 33 ( 8 – 40 ) independent studies were included in the meta-analysis. Figure 1 presents the detailed selection process.…”

Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study

“…Xu et al (2012) found that a loading dose of 1 mgÁkg À1 followed by a maintenance dose of 0.75 mgÁkg À1 had decreased pain scores and discharge time in patients undergoing cleft lip and palate surgery. Surana et al (2017) demonstrated that a loading dose of 1 mgÁkg À1 and an infusion of 0.5 mgÁkg À1 Áh À1 reduced intraoperative opioid and volatile anesthesia requirements, and prolonged the time to first postoperative rescue analgesic with similar PACU discharge times. Obayah et al (2010) showed that dexmedetomidine added to bupivacaine for a palatine nerve block, significantly reduced pain scores and prolonged the time to first analgesic request when compared with bupivacaine injection alone.…”

“…Unfortunately, the number of patients ≤1 is small and this sample is not sufficiently powered to detect a difference between groups. However, α-2 adrenergic receptor agonists have been used for cleft surgery without increasing complications (Jindal et al, 2011; Kayyal et al, 2014; Peng and Zhang, 2015; Surana et al, 2017). A final limitation is that we did not include an intravenous CLG in our study.…”

“…The effect of clonidine as an adjuvant for the suprazygomatic maxillary block has never been evaluated. Intravenous dexmedetomidine has been shown to reduce the incidence of EA after pediatric cleft palate surgery (Surana et al, 2017). This prospective, randomized double-blind study evaluated the use of an intraoperative suprazygomatic maxillary nerve block with a bupivacaine–clonidine mixture or with bupivacaine alone in a mixed pediatric–adult population undergoing cleft lip and palate surgery.…”

Efficaciousness of dexmedetomidine in children undergoing cleft lip and palate repair: a systematic review and meta-analysis

“…After excluding 50 studies, 13 studies including 1040 children aged 3 months to 12 years were finally included in this analysis. [12][13][14][15][16][17][18][19][20][21][22][23][24] The flow diagram of the literature search strategy is shown in figure 1.…”