Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2015.01.001
Brazilian Journal of Anesthesiology
Scientific Article

Effectiveness of dexmedetomidine for emergence agitation in infants undergoing palatoplasty: a randomized controlled trial

Eficácia de dexmedetomidina para o surgimento de agitação em lactentes submetidos à palatoplastia: estudo clínico randomizado

Aiji Boku; Hiroshi Hanamoto; Aiko Oyamaguchi; Mika Inoue; Yoshinari Morimoto; Hitoshi Niwa

http://dx.doi.org/10.1016/j.bjane.2015.01.001 Braz J Anesthesiol, vol.66, n1, p.37-43, 2016
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Abstract

OBJECTIVES: In infants, there is a high incidence of emergence agitation (EA) after sevoflurane (Sev) anesthesia. This study aimed to test the hypothesis that dexmedetomidine (Dex) administration would reduce the incidence and severity of EA after Sev-based anesthesia in infants undergoing palatoplasty. METHODS: A prospective randomized clinical trial was conducted with 70 patients undergoing palatoplasty, aged 10-14 months. Infants were randomly allocated into two groups: Dex (n = 35) and saline (n = 35). In the Dex group, Dex (6 µg/kg/h) was administered approximately 10 min before the end of the surgery for 10 min, followed by 0.4 µg/kg/h until 5 min after extubation. In the saline group, an equivalent amount of saline was administered in a similar manner. After the surgery, patients were transferred to the postanesthetic care unit (PACU). The infant's behavior and pain were assessed with scoring system for EA (5-point rating scale) and pain scale (PS; 10-point rating scale), respectively. EA and PS were estimated at six time points (after extubation, leaving the operating room, 0, 30, 60, and 120 min after arrival in PACU). RESULTS: EA and PS scores were significantly lower in the Dex group than in the saline group from extubation to 120 min after arrival in PACU. CONCLUSIONS: Dex administration has the advantage of a reduced EA and PS without any adverse effects. Dex provided satisfactory recovery in infants undergoing palatoplasty.

Keywords

Dexmedetomidine, Sevoflurane, Palatoplasty, Agitation, Infant, Post operative pain

Resumo

OBJETIVOS: Em crianças, é elevada a incidência de surgimento de agitação (SA) em seguida à anestesia com sevoflurano (Sev). Este estudo teve como objetivo testar a hipótese de que a administração de dexmedetomidina (Dex) reduziria a incidência e a gravidade do SA após anestesia com Sev em lactentes submetidos à palatoplastia. MÉTODOS: Estudo clínico prospectivo randomizado, feito com 70 pacientes submetidos a uma palatoplastia, com 10-14 meses. As crianças foram divididas randomicamente em dois grupos: Dex (n = 35) e solução salina (n = 35). No grupo de Dex, Dex (6 µg/kg/h) foi administrada cerca de 10 minutos antes do fim da cirurgia durante 10 minutos, seguida de 0,4 µg/kg/h até 5 minutos após a extubação. No grupo de solução salina, uma quantidade equivalente de salina foi administrada com o mesmo esquema de dosagem. Após a cirurgia, os pacientes foram transferidos para a unidade de cuidados pós-anestésicos (UCPA). O comportamento e a dor dos bebês foram avaliados com um sistema de pontuação para SA (escala de classificação de 5 pontos) e com uma escala de dor (ED; escala de classificação de 10 pontos), respectivamente. SA e ED foram estimados em seis pontos cronológicos (após a extubação, ao deixar a sala de cirurgia e 0, 30, 60 e 120 minutos após a chegada à UCPA). RESULTADOS: Os escores SA e ED foram significativamente menores no grupo Dex versus grupo salina, desde a extubação até 120 minutos após a chegada à UCPA. CONCLUSÕES: A administração de Dex tem a vantagem de uma redução no SA e na ED, sem quaisquer efeitos adversos. Dex proporcionou uma recuperação satisfatória em lactentes submetidos à palatoplastia.

Palavras-chave

Dexmedetomidina, Sevoflurano, Palatoplastia, Agitação, Bebê, Dor pós-operatória

References

Lerman J, Davis PJ, Welborn LG. Induction, recovery, and safety characteristics of sevoflurane in children undergoing ambulatory surgery. A comparison with halothane. Anesthesiol- ogy.. 1996;84:1332-40.

Baum VC, Yemen TA, Baum LD. Immediate 8% sevoflurane induc- tion in children: a comparison with incremental sevoflurane and incremental halothane. Anesth Analg.. 1997;85:313-6.

Keaney A, Diviney D, Harte S. Postoperative behav- ioral changes following anesthesia with sevoflurane. Paediatr Anaesth.. 2004;14:866-70.

Cohen IT, Finkel JC, Hannallah RS. Rapid emergence does not explain agitation following sevoflurane anesthesia in infants and children: a comparison with propofol. Paediatr Anaesth.. 2003;13:63-7.

Cole JW, Murray DJ, Mcalister JD. Emergence behavior in children: defining the incidence of excitement and agitation following anesthesia. Paediatr Anaesth.. 2002;12:442-7.

Aono J, Ueda W, Mamiya K. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology.. 1997;87:1298-300.

Wells LT, Rasch DK. Emergence delirium after sevoflurane anes- thesia: a paranoid delusion?. Anesth Analg.. 1999;88:1308-10.

Welborn LG, Hannallah RS, Norden JM. Comparison of emergence and recovery characteristics of sevoflurane, desflu- rane, and halothane in pediatric ambulatory patients. Anesth Analg.. 1996;83:917-20.

Veyckemans F. Excitation and delirium during sevoflurane anes- thesia in pediatric patients. Minerva Anestesiol.. 2002;68:402-7.

Guler G, Akin A, Tosun Z. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pedi- atric adenotonsillectomy. Paediatr Anaesth.. 2005;15:762-6.

Mili´c M, Goranovi´c T, Knezevi´c P. Complications of sevoflurane- fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study. Int J Oral Maxillofac Surg.. 2010;39:5-9.

Chen J, Li W, Hu X. Emergence agitation after cataract surgery in children: a comparison of midazolam, propofol and ketamine. Paediatr Anaesth.. 2010;20:873-9.

Hall JE, Uhrich TD, Barney JA. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg.. 2000;90:699-705.

Patel A, Davidson M, Tran MC. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillec- tomy and adenoidectomy. Anesth Analg.. 2010;111:1004-10.

Olutoye OA, Glover CD, Diefenderfer JW. The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy. Anesth Analg.. 2010;111:490-5.

Merkel SI, Voepel-Lewis T, Shayevitz JR. The FLACC: a behavioral scale for scoring postoperative pain in young chil- dren. Paediatr Nurs.. 1997;23:293-7.

Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. Br J Anaesth.. 2001;87:684-90.

Grant SA, Breslin DS, MacLeod DB. Dexmedetomidine infu- sion for sedation during fiberoptic intubation: a report of three cases. J Clin Anesth.. 2004;16:124-6.

Jalowiecki P, Runder R, Gonciarz M. Sole use of dexmedetomidine has limited utility for conscious sedation dur- ing outpatient colonoscopy. Anesthesiology.. 2005;103:269-73.

Nichols DP, Berkenbosch JW, Tobias JD. Rescue sedation with dexmedetomidine for diagnostic imaging: a preliminary report. Paediatr Anaesth.. 2005;15:199-203.

Koroglu A, Demirbilek S, Teksan H. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth.. 2005;94:821-4.

Young ET. Dexmedetomidine sedation in a pediatric cardiac patient scheduled for MRI. Can J Anaesth.. 2005;52:730-2.

Watcha MF, Ramirez- Ruiz M, White RF. Perioperative effects of oral ketorolac and acetaminophen in children under- going bilateral myringotomy. Can J Anaesth.. 1992;39:649-54.

Galinkin JL, Fazi LM, Cuy RM. Use of intranasal fen- tanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology.. 2000;93:1378-83.

Fairbanks CA, Stone LS, Wilcox GL. Pharmacological profiles of alpha 2 adrenergic receptor agonists identified using geneti- cally altered mice and isobolographic analysis. Pharmacol Ther.. 2009;123:224-38.

Correa-Sales C, Rabin BC, Maze M. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology.. 1992;76:948-52.

Arain SR, Ruehlow RM, Uhrich TD. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg.. 2004;98:153-8.

Cohen IT, Finkel JC, Hannallah RS. The effect of fentanyl on the emergence characteristics after desflurane or sevoflu- rane anesthesia in children. Anesth Analg.. 2002;94:1178-81.

Weldon BC, Bell M, Craddock T. The effect of caudal analge- sia on emergence agitation in children after sevoflurane versus halothane anesthesia. Anesth Analg.. 2004;98:321-6.

Isik B, Arslan M, Tunga AD. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth.. 2006;16:748-53.

Tobias JD. Dexmedetomidine: Applications in pediatric criti- cal care and pediatric anesthesiology. Pediatr Crit Care Med.. 2007;8:115-31.

Bejian S, Valasek C, Nigro JJ. Prolonged use of dexmedeto- midine in the pediatric cardiothoracic intensive care unit. Cardiol Young.. 2009;19:98-104.

Bloor BC, Ward DS, Belleville JP. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anes- thesiology.. 1992;77:1134-42.

Schnabel A, Reichl SU, Poepping DM. Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials. Paediatr Anaesth.. 2013;23:170-9.

Shurky M, Clyde MC, Kalarickal PL. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?. Paediatr Anaesth.. 2005;15:1098-104.

Ibacache ME, Munoz˜ HR, Brandes V. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthe- sia in children. Anesth Analg.. 2004;98:60-3.

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