Comparative study of the effect of two different doses of dexmedetomidine to prevent emergence agitation in tonsillectomy in children aged 2 to 12 years old

Abstract

Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children. Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney. Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups. Conclusion: A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.

Emergence delirium in children: Do the studies reflect reality?

“…ED is substantially overdiagnosed when pain is copresent, such as after adenotonsillectomy, a common surgery in many ED studies 5 . Crying, thrashing, and uncontrollable behavior, which are common responses to pain, are often misinterpreted by nonvalidated ED scales as ED, thereby inflating the frequency of ED.…”

“…The second consideration is that ED cannot be assessed before the child regains consciousness as the criteria used to diagnose ED require that the child is conscious. The third consideration is that ED can occur at any time after the child regains consciousness, not only at arbitrarily fixed time intervals in the PACU as reported by some investigators 5 . Because ED can occur at any time during the first 45 minutes after emergence from anesthesia, ED should be evaluated whenever the child exhibits characteristics that appear to be consistent with a PAED score > 10 rather than at fixed time intervals to avoid missing the diagnosis and therefore underestimating its frequency.…”

“…Because ED can occur at any time during the first 45 minutes after emergence from anesthesia, ED should be evaluated whenever the child exhibits characteristics that appear to be consistent with a PAED score > 10 rather than at fixed time intervals to avoid missing the diagnosis and therefore underestimating its frequency. The fourth consideration is that researchers mistakenly summarize serial PAED scores as measures of central tendency (e.g., means or medians) and dispersion (e.g., standard deviation or quartiles) by investigators, when ED scores are actually nominal data 5 . PAED scores <10 have no meaning either clinically or in terms of research nor can these scores be summarized as continuous data 5 .…”

“…The fourth consideration is that researchers mistakenly summarize serial PAED scores as measures of central tendency (e.g., means or medians) and dispersion (e.g., standard deviation or quartiles) by investigators, when ED scores are actually nominal data 5 . PAED scores <10 have no meaning either clinically or in terms of research nor can these scores be summarized as continuous data 5 . Therefore, summarizing the PAED scores as a measure of central tendency (mean or median) and dispersion is meaningless 5 .…”

“…PAED scores <10 have no meaning either clinically or in terms of research nor can these scores be summarized as continuous data 5 . Therefore, summarizing the PAED scores as a measure of central tendency (mean or median) and dispersion is meaningless 5 . The final consideration is that a score < 10 conveys a single meaning: ED is not present.…”