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

Yan-Zhuo Zhang,Jia-Min Wu,Xiao-Guang Cui,Xue Wang,Chun-Yu Song

doi:10.3389/fphar.2019.01091

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.

Highlights

Emergence agitation (EA) is a common pediatric complication with sevoflurane anesthesia
We sought to identify an optimal dose of dexmedetomidine to prevent EA without prolonged sedation and cardiovascular complications during tonsillectomy and adenoidectomy
Informed written consent to participate in this study was obtained from the parents and guardians of all of the children

Summary

Introduction

Emergence agitation (EA) is a common pediatric complication with sevoflurane anesthesia. Many techniques and medications, which include regional block (Aouad et al, 2005; Ghosh et al, 2011; Slinha and Sood, 2012), premedication (Kim et al, 2013; Zhang et al, 2013), propofol (Picard et al, 2000; Uezono et al, 2000; Kim et al, 2012), μ-opioid agonists (Li et al, 2012; Liang et al, 2014), and α2-agonists (Boku et al, 2016; Lin et al, 2016), have been used to reduce pediatric EA. We sought to identify an optimal dose of dexmedetomidine to prevent EA without prolonged sedation and cardiovascular complications during tonsillectomy and adenoidectomy. Emergence agitation (EA) is a common pediatric complication after sevoflurane anesthesia that can be prevented with dexmedetomidine. We evaluated the optimal dose (ED95) of dexmedetomidine for preventing EA with sevoflurane and remifentanil anesthesia after pediatric tonsillectomy and adenoidectomy

Methods

Results

Discussion

Conclusion