Optimal Dexmedetomidine Dose to Prevent Emergence Agitation Under Sevoflurane and Remifentanil Anesthesia During Pediatric Tonsillectomy and Adenoidectomy

Abstract

Background: Emergence agitation (EA) is a common pediatric complication after sevoflurane anesthesia that can be prevented with dexmedetomidine. However, an inappropriate dose of dexmedetomidine can cause prolonged sedation and cardiovascular complications. Thus, we evaluated the optimal dose (ED95) of dexmedetomidine for preventing EA with sevoflurane and remifentanil anesthesia after pediatric tonsillectomy and adenoidectomy. Methods: We enrolled American Society of Anesthesiologists (ASA) I and II children 3–7 years of age who underwent tonsillectomy with adenoidectomy. During induction, dexmedetomidine was infused for 10 min. Anesthesia was induced with sevoflurane and maintained with sevoflurane and remifentanil, resulting in a bispectral spectrum index (BIS) range from 40 to 60. Extubation time, surgical and anesthetic duration time, and duration time in the postanesthesia care unit (PACU) stay were recorded. EA [measured with Pediatric Anaesthesia Emergence Delirium (PAED) scores] and pain [measured with Face, Legs, Activity, Cry, Consolability (FLACC) scores] were assessed at extubation (E0), 15 min after extubation (E1), and 30 min after extubation (E2). If EA occurred, the next surgical procedure included increased dexmedetomidine by 0.1 μg/kg, and if not, the drug was reduced by 0.1 μg/kg. Results: The 50% effective dose (ED50) of dexmedetomidine for preventing EA after sevoflurane and remifentanil anesthesia for tonsillectomy and adenoidectomy was 0.13 μg/kg, and its 95% confidence interval is 0.09–0.19 μg/kg; ED95 was 0.30 μg/kg, and its 95% confidence interval is 0.21–1.00 μg/kg. Conclusion: Intravenous dexmedetomidine infusion at ED50 (0.13 μg/kg) or ED95 (0.30 μg/kg) during induction for 10 min can prevent half or almost all EA after sevoflurane and remifentanil anesthesia during pediatric tonsillectomy and adenoidectomy.

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

“…At present, there is no clear conclusion on the greatest dose of DEX for preventing EA in children. Zhang et al (96) revealed that intravenous DEX infusion at 0.30 μg/kg could prevent half of or all EA after general anesthesia during pediatric tonsillectomy and adenoidectomy. Manning et al (97) suggested that intravenous DEX 0.5 μg/kg could significantly reduce EA incidence in children with minimal side effects.…”

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

“…Meanwhile, dexmedetomidine can improve the cognitive function in children during recovery from general anesthesia ( 96 ) and contributes to dose-dependent inhibition of EA or ED after medical procedures ( 97 ). The optimal dose (ED 95 ) of dexmedetomidine for preventing EA was 0.30 μg/kg (95% CI: 0.21–1.00 μg/kg) ( 83 ). An animal experiment demonstrated that dexmedetomidine could enhance spatial learning and memory in neonatal rats under physiological conditions through promoting hippocampal neurogenesis ( 98 ).…”

Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

“…Various doses of dexmedetomidine were shown to assist in the prevention of EA after sevoflurane-based anesthesia in pediatrics [25]. Supporting evidence suggested by Zhang Y-Z et al [26] that a dose of 0.3 μg/kg dexmedetomidine prevented 95% of sevoflurane-associated ED during pediatric tonsillectomy and adenoidectomy.…”