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Dexmedetomidine Infusion for Prevention of Emergence Agitation in Children Undergoing Neurosurgery: A Prospective Study

Ma J, Yue H, Han R
Beijing Tiantan Hospital,Capital Medical University, Beijing, Beijing, China

Background: Emergence agitation (EA) occurs frequently in children during recovery from sevoflurane anesthesia[1]. EA can cause sudden rising of intracranial pressure, even intracerebral hematoma leading to severe outcomes in neurosurgical patients. Dexmedetomidine (DEX), a potent selective α₂ adrenergic agonist, can provide dose-dependent sedation and anesthetic-analgesia sparing effects with minimal respiratory depression[2]. Moreover, DEX has been reported for reducing EA in children undergoing tonsillectomy, spinal dysraphism surgery, gastrointestinal endoscopy and so on[3-5]. This prospective study aimed to assess the safety and efficacy of intraoperative DEX infusion on EA in children undergoing neurosurgery.

Methods: 60 children scheduled for craniotomy, aged 3-14 years and ASA I-II were randomly divided into two groups, those who received DEX (Group D, n=30) or normal saline (Group C, n=30). Anesthesia was induced with propofol, sufentanil and rocuronium and maintained with sevoflurane combined with remifentanil. At the beginning of closing the dura mater, the drug was accordingly given to each group by the anesthetist blinded to the study. The drug was administered by 0.5 μg/kg over 15 min followed by 0.6μg·kg¯¹·hour¯¹ infusion until the end of surgery in both groups. Heart rate (HR) and mean arterial pressure (MAP) were recorded just before DEX infusion and 5, 15, 30, 60 min after DEX infusion; before and 1, 3, 5min after the extubation. EA and choking scale, Ramsy scale, respiratory recovery and complications were assessed at arrival and every 15 min for up to 60 min in PACU. Sulfentanyl (0.1-0.2μg/kg) or propofol (1mg/kg) was given for rescue to the children with severe agitation lasting more than 5 minutes.

Results: There were no significant differences in HR and MAP before and after DEX infusion between the two groups (P> 0.05). However, HR and MAP after extubation were significantly lower in group D than Group C (P<0.01). The incidence of emergence agitation was significantly lower in group D than group C (42.9% vs. 3.3%, P<0.01). The incidences of choking and breathholding at the extubation, the percentages of rescue due to severe agitation were also significantly lower in group D than group C (P< 0.01).

Conclusions: Intraoperative infusion of dexmedetomidine decreased the incidences of emergence agitation, breathholding,choking and rescue during emergence period without delay of respiratory and consciousness recovery. It provides more stable hemodynamic condition during extubation without adverse hemodynamic effects.

References:
1.Yuen MY. Pediatric Anesthesia, 2010, 20: 256–264.
2.Rosen HD, et al. Journal of Canadian Anesthesia, 2013,60: 822–823
3.Meng QT, et al.. International Journal of Pediatric Otorhinolaryngology, 2012, 76: 1036–1041.
4.Nidhi G et al. Journal of Neurosurgical Anesthesiology, 2013, 25(3): 271-278.
5.Hasanin AS, et al. Egyptian Journal of Anaesthesia, 2014, 30: 21–26.

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