Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

Abstract

BackgroundTracheobronchial foreign body aspiration in children is a life-threatening, emergent situation. Currently, the use of fiberoptic bronchoscopy for removing foreign bodies is attracting increasing attention. Oxygen desaturation, body movement, laryngospasm, bronchospasm, and breath-holding are common adverse events during foreign body removal. Dexmedetomidine, as a highly selective α2-adrenergic agonist, produces sedative and analgesic effects, and does not induce respiratory depression. We hypothesized that intranasal dexmedetomidine at 1 μg kg − 1 administered 25 min before anesthesia induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under inhalation general anesthesia with sevoflurane.MethodsIn all, 40 preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 μg·kg − 1 or normal saline at 0.01 ml kg− 1 25 min before anesthesia induction. The primary outcome was the incidence of perioperative adverse events. Heart rate, respiratory rate, parent-child separation score, tolerance of the anesthetic mask, agitation score, consumption of sevoflurane, and recovery time were also recorded.ResultsFollowing pre-anesthesia treatment with either intranasal dexmedetomidine or saline, the incidences of laryngospasm (15% vs. 50%), breath-holding (10% vs. 40%), and coughing (5% vs. 30%) were significantly lower in patients given dexmedetomidine than those given saline. Patients who received intranasal dexmedetomidine had a lower parent–child separation score (P = 0.017), more satisfactory tolerance of the anesthetic mask (P = 0.027), and less consumption of sevoflurane (38.18 ± 14.95 vs. 48.03 ± 14.45 ml, P = 0.041). The frequency of postoperative agitation was significantly lower in patients given intranasal dexmedetomidine (P = 0.004), and the recovery time was similar in the two groups.ConclusionsIntranasal dexmedetomidine 1 μg·kg− 1, with its sedative and analgesic effects, reduced the incidences of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for FB removal. Moreover, it reduced postoperative agitation without a prolonged recovery time.Trail registrationThe study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017273) on July 20, 2018.

The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia—A Systematic Review and Meta-Analysis of Clinical Studies

“…The patients in 17 trials ( 20 , 22 , 28 – 30 , 32 , 39 , 43 , 49 , 50 , 52 , 54 , 61 , 64 , 72 , 74 , 78 ) underwent otolaryngology surgeries, those in 5 trials ( 36 , 44 , 66 , 67 , 70 ) underwent dental or cleft palate surgeries, those in 9 trials ( 19 , 26 , 38 , 40 , 53 , 55 – 57 , 63 ) underwent ophthalmic surgeries, those in 11 trials ( 21 , 27 , 33 , 34 , 37 , 41 , 42 , 47 , 68 , 69 , 71 ) underwent general or urological surgeries, those in 4 trials ( 23 , 31 , 62 , 73 ) underwent orthopedic surgeries, those in 1 trial ( 65 ) underwent cardiac surgery, those in 8 trials ( 24 , 45 , 46 , 58 – 60 , 75 , 79 ) underwent invasive examination or treatment, those in 5 trials ( 25 , 35 , 76 , 77 , 81 ) underwent non-invasive examination or treatment, and those in 3 trials ( 48 , 51 , 80 ) underwent all kinds of outpatient surgeries. Different routes of drug administration were used: intranasal in 12 trials ( 19 , 24 ...…”

“…Different routes of drug administration were used: intranasal in 12 trials ( 19 , 24 , 28 , 40 , 45 , 56 , 58 , 61 , 71 , 78 , 80 , 81 ), oral in 5 trials ( 36 , 66 – 69 ), caudal or nerve block in 5 trials ( 21 , 41 , 47 , 57 , 73 ), inhalation in 1 trial ( 60 ), transmucosal in 1 trial ( 20 ), and intravenous in 39 trials. The strategy of drug administration was also different: (1) intravenous single dose in 20 trials ( 22 , 23 , 25 , 29 , 30 , 32 – 35 , 42 , 48 – 50 , 53 – 55 , 59 , 63 , 64 , 72 ), loading dose plus maintenance infusion in 10 trials ( 26 , 31 , 37 , 43 , 52 , 74 – 77 , 79 ), and only maintenance infusion in 6 trials ( 38 , 39 , 44 , 51 , 62 , 65 ); and (2) administration onset before anesthesia in 29 trials ( 19 , 20 , 24 , 28 , 36 , 40 , 45 , 46 , 49 , 55 , 56 , 58 – …”

“…Random sequence generation was assessed as a low risk of bias in 57 studies (98%), allocation concealment was assessed in 36 studies (62%), blinding of participants was assessed in 38 studies (66%), blinding of outcome assessment was assessed in 34 studies (59%), incomplete outcome data were assessed in 58 studies (100%), and selective outcome reporting was assessed in 56 studies (97%). Nineteen RCTs ( 24 , 26 , 27 , 32 , 33 , 37 , 41 , 45 , 53 , 54 , 56 , 58 – 61 , 64 , 67 , 73 , 81 ) were assessed to be of high quality ( Supplementary Figures 1 , 2 ). Bias risk of 5 CCTs ( 36 , 46 , 65 , 66 , 76 ) was assessed by NOS, and the number of stars was 7 from the study of Keles et al ( 36 ), 8 from the study of Riveros et al ( 46 ), 5 from the study of Jiang et al ( 65 ), 5 from the study of Long et al ( 66 ), and 8 from the study of Mason et al ( 76 ), respectively.…”

Perioperative management of severe life-threatening airway obstruction caused by an accidentally inhaled foreign body in an 11-month-old child: A case report

“…In our hospital, general anesthesia is used for clinical AFB removal. A laryngeal mask airway is inserted, and the AFB is removed under general anesthesia via the laryngeal mask airway [12] . The minimum inner diameter of the tracheal 122 tube used is 4.5 mm, even for children undergoing tracheal foreign body removal under general anesthesia via tracheal intubation.…”

A National Population Cohort Study Showed That Exposure to General Anesthesia in Early Childhood Is Associated with an Increase in the Risk of Developmental Delay

“…There is increasing evidence that type A gamma-amino butyric acid (GABAA) receptors, which is excitatory rather than inhibitory in the immature neurons, are the main target of sevoflurane. Moreover, sevoflurane is the main inhalation anesthetic used in pediatric surgery [2,4] due to its pleasant odor [5], and it also exerts a protecting effect against bronchoconstriction [6]. The excitotoxic effects of GABAA receptors are related to the increase in neuronal apoptosis after exposure to sevoflurane in animals, which might contribute to sevoflurane-induced subsequent cognitive dysfunction [2].…”