Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery

Abstract

Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.

Evaluation of the Adding Paracetamol to Dexmedetomidine in Pain Management After Adult Cardiac Surgery

“…It can inhibit nausea and vomiting, and shivering after surgery. It also reduces postoperative delirium (16). Several studies have shown that this drug, when is used alone, can cause analgesia and sedation without respiratory depression (17,18).…”

Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review

“…tion, dexmedetomidine has also been used for sedation during awake fibreoptic intubation (16), reducing emergence delirium in children for strabismus surgery (17), premedicating children undergoing dental procedures (18), reducing the hemodynamic changes during elective colonoscopy (19), improving post-cesarean analgesia (20), sedating patients for closed reduction of nasal fractures (21), providing controlled hypotension during functional endoscopic sinus surgery (22), and reducing postoperative cognitive dysfunction (POCD) after middle ear surgery under hypotensive technique (23). Dexmedetomidine has also been used more importantly as an adjuvant to improve chronic and neuropathic pain and prolong the effects of chronic pain procedures (24).…”

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

“…Many efforts have been made to find newer analgesics and reduce the severity of postoperative pain to reduce the need for using opioid analgesics ( 18 , 19 ). One of the most popular drugs is dexmedetomidine, which is a selective alpha-2 adrenergic agonist with high specificity and has a strong anesthetic effect ( 20 , 21 ). The use of dexmedetomidine, alone or in combination with other drugs, improves hemodynamic stability by having several favorable effects, including analgesic effects, inhibition of sympathetic outputs, anti-anxiety properties, and reduction of norepinephrine levels ( 22 , 23 ).…”