Effect of xenon and dexmedetomidine as adjuncts for general anesthesia on postoperative emergence delirium after elective cardiac catheterization in children: study protocol for a randomized, controlled, pilot trial

Abstract

Background: Emergence delirium, a manifestation of acute postoperative brain dysfunction, is frequently observed after pediatric anesthesia and has been associated with the use of sevoflurane. Both xenon and dexmedetomidine possess numerous desirable properties for the anesthesia of children with congenital heart disease, including hemodynamic stability, lack of neurotoxicity, and a reduced incidence of emergence delirium. Combining both drugs has never been studied as a balanced-anesthesia technique. This combination allows the provision of anesthesia without administering anesthetic drugs against which the Food and Drug Administration (FDA) issued a warning for the use in young children. Methods/Design: In this phase-II, mono-center, prospective, single-blinded, randomized, controlled pilot trial, we will include a total of 80 children aged 0-3 years suffering from congenital heart disease and undergoing general anesthesia for elective diagnostic and/or interventional cardiac catheterization. Patients are randomized into two study groups, receiving either a combination of xenon and dexmedetomidine or mono-anesthesia with sevoflurane for the maintenance of anesthesia. The purpose of this study is to estimate the effect size for xenon-dexmedetomidine versus sevoflurane anesthesia with respect to the incidence of emergence delirium in children. We will also describe group differences for a variety of secondary outcome parameters including peri-interventional hemodynamics, emergence characteristics, incidence of postoperative vomiting, and the feasibility of a combined xenon-dexmedetomidine anesthesia in

Analysis of Anesthesia Effect of Dexmedetomidine in Clinical Operation of Replantation of Severed Finger

“…Dexmedetomidine is an agonist of the α 2 adrenergic receptor [ 6 ]. The literature [ 7 ] found in the in vitro study of frog sciatic nerve conduction with high concentration of dexmedetomidine that the reduction of the compound's action potential is concentration-dependent rather than α 2 mediated. In vivo and in vitro studies have found that the effect of clonidine, another α 2 adrenergic receptor agonist, on peripheral nerves may be mediated by blocking the cation current activated by hyperpolarization, rather than due to the agonistic effects of α 2 adrenergic receptors.…”

Xenon’s Sedative Effect Is Mediated by Interaction with the Cyclic Nucleotide-Binding Domain (CNBD) of HCN2 Channels Expressed by Thalamocortical Neurons of the Ventrobasal Nucleus in Mice

“…Continuous improvement of extraction techniques has already reduced the price to a comparable level with other inhaled anesthetics [31]. Xenon would be favored over other anesthetics in high-risk surgeries [4] and is currently in a clinical trial for use in pediatric surgery [32]. Consequently, unraveling the pharmacological mechanism of how xenon produces sedation and anesthesia helps to assess its clinical use regarding the application to patients' risk and safety.…”

The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

“…For example, delirium is a behavioral disturbance in the child, which is characterized by crying, thrashing, inconsolability, and disorientation in the early postanesthetic period. 10,11 We considered that observation of postoperative behavior and complications could better assess the safety of dexmedetomidine in children. Although generally considered to be minor adverse effects, PONV is a common postoperative adverse reaction that may increase patient discomfort, cause severe complications, and delay patient discharge.…”