<p>Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial</p>

Abstract

ObjectivesEmergence delirium (ED) is a common neurologic complication that can not only distress children and their families in the early postanesthetic period, but can also have adverse effects on children in the long-term. This study aimed to investigate the effects of single-dose dexmedetomidine on ED in children with sevoflurane anesthesia and to observe postoperative behavioral changes through long-term follow-up.MethodsPatients aged 2–7 years, American Society of Anesthesiologists class (ASA) I or II, scheduled for tonsillectomy with and without adenoidectomy were randomized to receive dexmedetomidine 0.5 μg/kg (Group D) or volume-matched normal saline (Group C) over 10 minutes after induction of anesthesia. The primary outcome was the incidence of ED within 30 minutes after extubation. Other outcomes were the incidence of pain, extubation time, post-anesthesia care unit (PACU) length of stay after extubation, adverse events, and the incidence of negative postoperative behavioral changes (NPOBCs).ResultsNinety children completed the study. Compared with the control group (Group C), dexmedetomidine decreased the incidence of ED (31.1% vs 53.3%; P=0.033) and pain (28.9% vs 57.8%; P=0.006), but it prolonged extubation time (P⩽0.001). PACU length of stay after extubation and the percentage of adverse events were similar between groups. The incidence of NPOBCs in Group D was significantly lower at 1 and 7 days after discharge (33.3% vs 60.0%; P=0.011% and 24.4% vs 46.7%; P=0.028, respectively) than it was in Group C, but no significant difference was found at the 30th day.ConclusionDexmedetomidine 0.5 μg/kg reduced the incidence of ED after sevoflurane anesthesia and might be used to prevent NPOBCs.Clinical trials registrationChiCTR1800016828.

Effect of Dexmedetomidine in children undergoing general anaesthesia with sevoflurane: a meta-analysis and systematic review

“…A total of 24 RCTs were included in the present meta-analysis. [4][5][6][7][8][9][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The results showed that, compared with placebo, Dex was associated with positive effects on recovery quality in children undergoing general anaesthesia with sevoflurane, reducing nausea and vomiting and shortening the eye-opening time, extubation time, and duration of PACU stay. Unlike the present study, Amorim et al 10 reported that Dex reduced the incidence of emergence agitation while prolonging the duration of PACU stay and eye-opening time.…”

“…35 Dex is a highly selective agonist of a-adrenergic receptors, having sedative, analgesic and anxiolytic effects at clinical doses without affecting the patient's breathing, 30 and it has been widely applied for anaesthesia in children. 7,8,36 Dex induces the activation of a2 receptors and stimulates blue-spot receptors, which can then affect the endogenous sleep pathway, mimicking the sedation that occurs in natural sleep. 37,38 Furthermore, a2 receptors in the spinal cord can also have certain analgesic effects, which will improve the recovery quality after general anaesthesia, probably by mainly reducing the occurrence of agitation during recovery.…”

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

“…A select few patients may end up having emergence delirium with the risk being higher in pediatric age groups and the elderly population. The incidence has been reported up to 80% in pediatric age group and this can increase risk of postoperative respiratory depression and airway obstruction [26].…”

Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children

“…Postoperative maladaptive behaviors have also been associated with preoperative distress (Fortier & Kain, 2015;Hayhoe et al, 2016). The most common postoperative maladaptive behaviors observed in children include nighttime crying, enuresis, separation anxiety, nightmares, apathy, withdrawal, decreased appetite, thrashing, and inconsolability (Harbaugh & Gadepalli, 2019;Rosenbaum, Kain, Larsson, Lönnqvist, & Wolf, 2009;Shi et al, 2019). These negative behaviors are believed to decrease over time; however, Kain, Mayes, Wang, and Hofstadter (1999) found that 67% of the children developed new maladaptive behaviors the day after surgery, 45% displayed these behaviors on day two after surgery, and 23% of them at two weeks after surgery.…”