Randomized controlled trial on influence of nasal administration of dexmedetomidine after induction of anesthesia on agitation of children in ophthalmologic surgery

Abstract

Objective To observe the influence of nasal administration of dexmedetomidine after induction of anesthesia on agitation of children in ophthalmologic surgery. Methods The study was designed as a randomized, double-blind and controlled trial. The children who underwent the ophthalmologic surgery in Department of Ophthalmology, Beijing Tongren Hospital from March to October 2015 were divided into the dexmedetomidine group and the control group by a table of random number. After the induction of anesthesia, all the children received the laryngeal mask (LMA) and the intranasal drugs were sprayed through the nasal mucosal drug delivery device (LMA MAD Nasal™). The dexmedetomidine group received hydrochloride dexmedetomidine injection (1 μg/kg) and the control group received 0.9% sodium chloride injection (0.01 ml/kg). The separation condition between the children and the parents in the 2 groups were judged by Ibrahim's 4 comment method before operation. The children's heart rate, systolic blood pressure, respiratory frequency and pulse oxygen saturation (SpO2) were recorded at the different time points (before induction momentarily, 2 minutes after laryngeal mask insertion, 10 minutes after giving the intranasal drugs, 10 minutes after the starting of operation and the end of operation, respectively). The anesthesia time, operation time, staying time in post anesthesia care unit (PACU) and postoperative emergence agitation were also recorded. The children'waking condition in PACU were evaluated by Sundaram's 4-point score after operation. Results A total of 97 children were enrolled in this study. The dexmedetomidine group comprised 47 cases and the control group 50 cases. The differences in age, sex and body weight between the 2 groups were not statistically significant (all P>0.05). The number of cases who had separation difficulty in the dexmedetomidine group and the control group were 26 (55.3%) and 18 (36.0%), respectively. The differences was not statistically significant. The differences in heart rate, systolic pressure; respiratory frequency, SpO2 and staying time in PACU between the children in the 2 groups at different time points during perioperative period were not statistically significant (all P>0.05). The incidence of emergence agitation during recovery period in the dexmedetomidine group was lower than that in the control group[14.9%(7/47) vs 40.0%(20/50)], and the difference was statistically significant (P=0.007). Conclusion Nasal administration of dexmedetomidine after induction of anesthesia (1 μg/kg) may decrease the incidence of emergence agitation during recovery period after general anesthesia and be propitious to children'postoperative recovery. Key words: Dexmedetomidine; Intranasal; Administration, intranasal; Child; Agitation