DEXMEDETOMIDINE REDUCES AGITATION AND PROVIDES SMOOTH EXTUBATION AFTER PEDIATRIC ADENOTONSILLECTOMY

Abstract

Background: Emergence agitation(EA) is a frequent postoperative complication in pediatric patients undergoing adenotonsillectomy under sevoflurane anaesthesia.

OBJECTIVE: The aim of the study was to evaluate the role of dexmedetomidine on EA and extubation in pediatric adenotonsillectomy patients under sevoflurane anaesthesia.

STUDY DESIGN: Prospective randomized study.

PARTICIPANTS: Patients aged 4-14 years with ASA 1-2 undergoing adenotonsillectomy under sevoflurane anaesthesia were enrolled in the study.

METHODS: After ethical committee approval and written informed consent from all the patient's parent/guardian, 60 patients were randomised into two groups to receive either dexmedetomidine or placebo. Tracheal extubation time and emergence time were recorded. The subject’s postoperative behaviour was assessed using Pediatric Anesthesia Emergence Delirium (PAED) scale and intensity of pain was assessed by using an Observational Pain Score (OPS).

RESULT: Both the groups were comparable in terms of demographic data. The patients in the dexmedetomidine group had lower PEAD score and OPS score on arrival to post-anaesthesia care unit as well as 60 minutes postoperatively and the difference was found to be statistically significant (p-value < 0.05). The incidence of EA was 6.7%(2/30) in dexmedetomidine group in comparison to 36.7%(11/30) in placebo. The extubation time was prolonged and no significant side effects were noted.

CONCLUSION: Single dose of dexmedetomidine was found to be associated with a statistically significant decrease in the incidence of EA with smooth extubation, lower pain score along with a shorter duration of stay in the post-anaesthesia care unit. Although the extubation was prolonged in the dexmedetomidine group in comparison to the placebo.

IMPLICATIONS: Single-dose dexmedetomidine (0.5 mcg/kg)  was seen to be associated with a lower incidence of EA along with smoother extubation in pediatric patients undergoing adenotonsillectomy with sevoflurane anaesthesia.