Dexmedetomidine versus fentanyl in anesthesia of cochlear implantation in pediatric patients

Abstract

BackgroundAnesthesia for cochlear implantation in pediatrics mandates deliberate hypotension to provide a better surgical field. Dexmedetomidine is α2 adrenoceptor agonist that provides adequate sedation with high cardiovascular stability. We aimed to compare it with fentanyl as an anesthetic adjuvant.Methods52 pediatric patients (ASA I or II), undergoing cochlear implantation were randomized into dexmedetomidine (D) group and fentanyl (F) group (n = 26 for each). Anesthesia was induced by I.V. dexmedetomidine in (D) group at a bolus dose of 0.4 μg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.4 μg/kg/h until the end of surgery. In (F) group; anesthesia was induced by I.V. fentanyl at a dose of 1 μg/kg over 10 min, then continuous infusion by a rate of 1 μg/kg/h. This is followed by I.V. propofol and atracurium for both groups. Maintenance was done without additional muscle relaxant to allow monitoring of the facial nerve. Both groups were compared as regards the quality of the surgical field, intraoperative hemodynamics, recovery and discharge time, postoperative pain using objective pain score and the need for rescue analgesics and anti-emetics in postanesthesia care unit (PACU).ResultsDexmedetomidine group showed a decreased heart rate and mean arterial pressure than fentanyl group. These parameters were significantly decreased compared to the baseline throughout the procedure in D group. The quality of the surgical field was significantly better in D group than in F group. Postoperative pain and complications were not different between the two groups. Recovery and discharge time was significantly shorter for the patients in D group than in F group (p < 0.05).ConclusionDexmedetomidine infusion in cochlear implantation in pediatric patients was better in inducing deliberate hypotension and providing better quality scale of surgical field compared to fentanyl infusion. It allowed rapid recovery from anesthesia and reduced need for pain medication in the PACU.