Comparatative Study Between Dexmedetomidine And Fentanyl For Analgesia And Prevention Of Emergence Agitation In Children Undergoing Cochlear Implantation

Abstract

Aim of the work:The main objective will to compare fentanyl with Dexmedetomidine as regards; 1. Their efficacy 2. Provide better quality of surgical field during cochlear implantation. in including deliberate hypotension. 3. The effect of both drugs on postoperative pain. 4. Recovery time. 5. Emergence agitation.. Patient and Methods:The study was conducted after approval of the Ethical committee of Sohag university Hospital and obtaining informed written consent from the parents of the patients. 50 pediatric patients (ASA I or II), undergoing cochlear implantation were randomized into dexmedetomidine (D) group and fentanyl (F) group. Anesthesia was induced by I.V. dexmedetomidine in (D) group at a bolus dose of 2 micg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.7 micg/kg/h until the end of surgery. In (F) group; anesthesia was induced by I.V. fentanyl at a dose of 1 micg/kg over 10 min, then continuous infusion by a rate of .0.1 mg/kg/h. This is followed by I.V. propofol and atracurium for both groups. Both groups were compared as regards the quality of the surgical field, intraoperative hemodynamics, recovery and discharge time, postoperative pain using objective pain score and the need for rescue analgesics and anti-emetics in post anesthesia care unit (PACU). .Results: Dexmedetomidine group showed a slight decrease in heart rate than fentanyl group. These parameters were significantly decreased compared to the baseline throughout the procedure in D group. Modified Aldrete Score is better with D group compared to F group . There was significant difference between both group as regard objective pain score. There was a significant difference between two groups, as the time for recovery was more rapid in D (group) than in F (group) the data is significant. Conclusion : Dexmedetomidine infusion in cochlear implantation in pediatric patients was better in inducing deliberate hypotension. It allowed rapid recovery from anesthesia and reduced need for pain medication in the PACU.