Comparison of dexmedetomidine in two different doses on emergence agitation in children under sevoflurane anaesthesia: A double-blind randomised controlled trial

Investigating the Effect of Dexmedetomidine in Controlling Postoperative Emergence Agitation in Children under Sevoflurane Anesthesia

Introduction

Emergence agitation (EA) is one of the common problems during recovery from general anesthesia, especially in children. In this study, we investigated the effect of dexmedetomidine on the control of agitation after anesthesia with sevoflurane in children.

Method

This randomized control-placebo, double-blind prospective clinical trial was conducted on seventy-six children between 2 and 7 years with ASA (American Society of Anesthesiologists) class I who were candidates for elective adenoidectomy surgery and tonsillectomy. Participants were selected by an available sampling method. Patients were randomly placed in one of the two groups D (dexmedetomidine 0.5 μg/kg infusion within ten minutes) or P (placebo: normal saline infusion within ten minutes). A four-point scale evaluated agitation. Pain evaluation was done by FLACC (faces, legs, activity, cry, and consolability). The statistical software was SPSS version 23. P < 0.05 was considered statistically significant.

Results

The level of agitation was significantly lower in the intervention group (P < 0.05), except after 40 minutes in the PACU (Post Anesthesia Care Unit) (P=1.00). Patients in the control group experienced high pain scores when admitted at PACU, 10, 20, and 30 minutes after admission at PACU (P < 0.05). Pethidine and metoclopramide prescriptions in the intervention group were lower than in the control group (P < 0.05). Shivering occurred in five patients in the intervention group and nine in the control groups (P=0.032). Hypotension that required intervention occurred in 3 patients in the intervention group and one in the control group (P=0.024).

Conclusion

Our trial demonstrated that the prescription of 0.5 μg/kg of dexmedetomidine within ten minutes after intubation significantly reduced the EA frequency, pain severity, analgesic consumption, and PONV (postoperative nausea and vomiting). However, it caused delays in the emergence from anesthesia. This trial is registered with IRCT20160430027677N14.

Postoperative agitation or delirium in paediatric patients. What we know and how to avoid it

Emergence delirium or postoperative agitation is the name given to the state of altered consciousness that occurs after surgery and especially affects pediatric patients. Its incidence is not negligible, reaching 80% of cases in certain studies. It is frequently confused with other clinical entities, for which reason a scale has been validated to facilitate its diagnosis. Risk factors include age under 5 years, the presence of pain after surgery and especially intense preoperative anxiety. Pediatric emergence delirium presents as an adverse event after surgery and influences patient safety by significantly increasing patient comorbidity. It is essential to recognize the entity, as well as its risk factors, in order to apply effective preventive measures to reduce its incidence and intensity when it occurs.

Functional Magnetic Resonance Imaging of Brain Function and Emergence Agitation of Patients with Dexmedetomidine-Assisted General Anesthesia under Comfortable Nursing Intervention

In order to explore the effects of dexmedetomidine (DEX) on functional magnetic resonance imaging (fMRI) and emergence agitation of patients who underwent general anesthesia surgery with sevoflurane under comfortable nursing intervention, 66 patients who received upper abdominal surgery were selected as research objects. According to nursing and anesthesia methods, the patients were randomly divided into control group (routine nursing and anesthesia), group A (routine nursing and DEX-assisted anesthesia), and group B (comfortable nursing and DEX-assisted anesthesia). The differences in the brain fMRI characteristics, hemodynamic indexes, anesthesia recovery indexes, and nursing satisfaction in the perioperative period were evaluated. The results showed that the regional homogeneity values were different in different brain regions, but there was no difference in the Z value of functional connectivity(P > 0.05). Compared with the control group, heart rate, mean arterial pressure, awakening time, extubation time, the Riker sedation-agitation scale (SAS) score, and anesthetic dosage were signally decreased in group A and group B, while the Ramsay scores, the postanesthesia care unit (PACU) stay, and anesthesia maintenance time in the two groups was obviously increased(P < 0.05). Compared with group A, the extubation time, the SAS score, PACU stay, and hospital stay were all remarkably reduced in group B, while the nursing satisfaction score was greatly increased(P < 0.05). To sum up, DEX was helpful to safely and effectively reduce the occurrence of emergence agitation in patients under general anesthesia surgery with sevoflurane. Besides, comfortable nursing intervention could further reduce the incidence of emergence agitation in patients with general anesthesia, shorten the length of hospital stay, and improve nursing satisfaction.

Adoption of Dexmedetomidine in Different Doses at Different Timing in Perioperative Patients

Dexmedetomidine (Dex) is an alpha-2 agonist used for sedation during various procedures. Dex activates 2-adrenoceptors, and causes the decrease of sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; it reduces anesthetic and opioid requirements; and causes sedation and analgesia.

OBJECTIVE

it was to compare the perioperative effects of different doses of Dex at different timing in patients using Dex during the perioperative period adopting a medical data classification algorithm based on optimized semi-supervised collaborative training (Tri-training).

METHODS

495 patients requiring surgical treatment in Xingtai People's Hospital were randomly selected as the study subjects. The patients were divided into group A (used before induction), group B (used during induction), and group C (used after induction) according to different induction timing, with 165 cases in each group. Then, groups A, B, and C were divided into groups A1, B1, and C1 (0.4 μg/(kg·h) rate), groups A2, B2, and C2 (0.6 μg/(kg·h) rate), and groups A3, B3, and C3 (0.8 μg/(kg·h) rate) according to the dose used, with 55 cases in each group. Intraoperative anesthesia and postoperative adverse reactions were compared among the 9 groups.

RESULTS

the similarity between the Tri-training algorithm optimized by Naive Bayes (NB) classification algorithm and the actual classification (93.49%) was clearly higher than that by decision tree (DT) and K-nearest neighbor (kNN) classification algorithm (76.21%, 74.31%); heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) values decreased obviously after Dex used in groups B1, C1, B2, C2, B3, and C3 (P <0.05), but did not change significantly in groups A1, A2, and A3 (P >0.05); the proportion of patients with satisfactory Ramsay score in group A3 was distinctly superior than that in groups A1, A2, B1, B2, B3, C1, C2, and C3 (P <0.05); the incidence of adverse reactions in group A3 was significantly inferior than that in groups A1, A2, B1, B2, B3, C1, C2, and C3 (P <0.05).

CONCLUSION

the optimization effect of NB classification algorithm was the best, and the injection of Dex at the injection rate of 0.8 μg/(kg·h) before induction of anesthesia could apparently improve the fluctuation of HR, SBP, and DBP during perioperative period, and effectively reduce the occurrence of adverse reactions in patients, with better sedative effect on patients.