Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anaesthesia

Abstract

BACKGROUND Emergence agitation is a common paediatric complication after inhalational anaesthesia. Intranasal dexmedetomidine can prevent emergence agitation effectively, but the optimal dose is uncertain.OBJECTIVE The aim of our study was to investigate the 95% effective dose (ED 95 ) of intranasal dexmedetomidine for the prevention of emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery.DESIGN A prospective, randomised, placebo-controlled, double-blind, clinical trial. SETTINGThe study was conducted in Guangzhou Women and Children's Medical Center in China from August 2017 to December 2018.PATIENTS Three hundred and eighteen children scheduled for ambulatory surgery were enrolled into two age groups of less than 3 years and at least 3 years. INTERVENTIONSThe children in each age group were randomised into five equal subgroups to receive either intranasal dexmedetomidine 0.5, 1.0, 1.5 or 2.0 mg kg À1 (Groups D 0.5 , D 1.0 , D 1.5 and D 2.0 ), or intranasal isotonic saline (group C) after induction.MAIN OUTCOME MEASURES The primary outcome was the ED 95 dose of intranasal dexmedetomidine for preventing emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery. RESULTSThe incidences of emergence agitation for Groups C, D 0.5 , D 1.0 , D 1.5 and D 2.0 were 63, 40, 23, 13 and 3% in children less than 3 years, and 43, 27, 17, 7 and 3% in children at least 3 years. The ED 95 of intranasal dexmedetomidine for preventing emergence agitation was 1.99 mg kg À1 [95% confidence interval (CI), 1.83 to 3.80 mg kg À1 ] in children less than 3 years, and 1.78 mg kg À1 (95% CI, 0.93 to 4.29 mg kg À1 ) in children at least 3 years. LMA removal time for groups D 1.5 and D 2.0 was 9.6 AE 2.2 and 9.7 AE 2.5 min, respectively, for children less than 3 years, and 9.4 AE 2.0 and 9.9 AE 2.7 min in children at least 3 years, respectively. Length of stay in the postanaesthesia care unit for Groups D 1.5 and D 2.0 was 34.3 AE 9.6 and 37.1 AE 11.2 min, respectively, in children less than 3 years, and 34.7 AE 10.2 and 37.3 AE 8.3 min in children at least 3 years, respectively. These times were longer in the D 1.5 and D 2.0 subgroups than in the control subgroup in the two age groups of less than 3 years and at least 3 years, respectively: 7.2 AE 1.9 min in children less than 3 years and 7.3 AE 2.5 min in children at least 3 years for LMA removal time, 22.2 AE 7.9 min in children less than 3 years and 22.0 AE 7.7 min in children at least 3 years for PACU stay time in control subgroup, respectively (P < 0.05).CONCLUSION Intranasal dexmedetomidine prevented emergence agitation after paediatric surgery in a dose-dependent manner. The optimal dose of intranasal dexmedetomidine for preventing emergence agitation was higher in younger children.

Effects of different doses of intranasal dexmedetomidine on related complications and parents’ satisfaction in anesthetized children: a systematic review

“…Among these, full text could not be found for one article, and after reading the remaining 71 articles, 51 articles that did not meet the inclusion criteria were excluded. Finally, 20 RCTs were included in this network metaanalysis [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The flowchart is shown in Fig.…”

“…Nine studies [16,18,20,21,24,26,27,32,34] reported the incidence of emergence agitation. The network metaanalysis revealed that after compared to normal saline, intranasal DEX intervention at 1 µg/kg [RR = 0.305, 95%CI= (0.154, 0.579)], 1.5 µg/kg [RR = 0.276, 95%CI= (0.085, 0.905)], and 2 µg/kg [RR = 0.163, 95%CI= (0.059, 0.373)] significantly decreased the incidence of emergence agitation.…”

Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study

“…EA is a common postoperative complication that can result in bleeding or ripping of the surgical incision, tracheal tube dislodgement, and in severe cases, aspiration, cardiovascular accidents, and asphyxia. 20 This significantly jeopardizes the safety and prognosis of elderly patients during surgery. Therefore, the development of a safe and effective anesthetic plan for senior patients is of utmost importance.…”

The Effect of Intranasal Dexmedetomidine on Emergence Delirium Prevention in Pediatric Ambulatory Dental Rehabilitation Under General Anesthesia: A Randomized Clinical Trial

“…A previous study found that the ED95 of intranasal dexmedetomidine for preventing emergency agitation was 1.78 μg/kg in children aged 3 to 10 years. 27 This may indicate that 2 μg/kg may be a better choice than 1 μg/kg for prophylactic usage. Meanwhile, dexmedetomidine has a moderate analgesic effect 28 and has been proven to be effective in postoperative pain relief in pediatric maxillofacial surgery.…”