Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

Abstract

Background: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. Methods: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes. Results: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. Conclusions: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Anesthesia, the developing brain, and dexmedetomidine for neuroprotection

“…Existing studies related to neuroprotection are limited by heterogeneity that limits broad applicability. Many of the studies reviewed included pediatric patients undergoing elective procedures at low risk, ranked as American Society of Anesthesiologists (ASA) Physical Status Classification System class I or II ( 91 , 92 , 94 , 95 , 97 , 98 ). Future studies including high risk patients undergoing major surgeries and emergency surgeries with higher ASA classes may be included to contribute to the data and research in the application of dexmedetomidine for neuroprotection in the general population.…”

“…Dexmedetomidine also has a role in treating emergence agitation (EA) in the pediatric population. Shafa et al compared the effectiveness of two distinct doses of dexmedetomidine (1 μg/kg and 2 μg/kg) versus placebo in treating agitation, which was measured using PAEDS in pediatric patients undergoing adenotonsillectomy ( 97 ). The researchers found that the use of dexmedetomidine at both doses was associated with a significant reduction in agitation upon emergence ( 97 ).…”

“…Shafa et al compared the effectiveness of two distinct doses of dexmedetomidine (1 μg/kg and 2 μg/kg) versus placebo in treating agitation, which was measured using PAEDS in pediatric patients undergoing adenotonsillectomy ( 97 ). The researchers found that the use of dexmedetomidine at both doses was associated with a significant reduction in agitation upon emergence ( 97 ). There are also further studies comparing dexmedetomidine bolus versus continuous infusion and the effect on EA.…”