Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2018.05.001
Brazilian Journal of Anesthesiology
Scientific Article

Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial

Efeito de duas doses diferentes de dexmedetomidina na incidência de agitação ao despertar após cirurgia para correção de estrabismo: um ensaio clínico randômico

Khaled Abdel-Baky Abdel-Rahman; Sayed Kaoud Abd-Elshafy; Jehan A. Sayed

http://dx.doi.org/10.1016/j.bjane.2018.05.001 Braz J Anesthesiol, vol.68, n6, p.571-576, 2018
PDF English
PDF Português
Downloads: 0
Views: 908

Abstract

Abstract Background and objective: Emergence agitation is a postoperative negative behavior that affects mainly children. We studied the effect of two different doses of dexmedetomidine on the incidence and degree of EA in children undergoing strabismus surgery. Methods: 90 patients were allocated into three equal groups; patients received 0.5 µg.kg−1 of dexmedetomidine in high Dex group, 0.25 µg.kg−1 of dexmedetomidine in low Dex group, or normal saline in the placebo group. All drugs were received with the closure of the conjunctiva before the end of the surgery. Pediatric Anesthesia Emergence Delirium (PAED) scale was used to evaluate the agitation, and Face, Legs, Activity, Cry, Consolability (FLACC) scale was used for pain assessment. Adverse effects of dexmedetomidine and recovery times were recorded. Results: The incidence of agitation was significantly lower in high Dex group compared to other groups and it was significantly lower in low Dex group compared to placebo group. The median (range) of FLACC score was significantly lower in both Dex groups compared to placebo group. Recovery times; time from removal of laryngeal mask to eye opening and time stay in post anesthesia care unit was significantly longer in high Dex group compared to other groups. No significant bradycardia or hypotension was recorded. Recovery time was significantly longer in high Dex group compared to the other two groups. Conclusion: Dexmedetomidine (0.5 µg.kg−1) before emergence from general anesthesia resulted in a reduction in the incidence of emergence agitation compared to a dexmedetomidine (0.25 µg.kg−1) but on the expense of recovery times without adverse effects.

Keywords

Children, Dexmedetomidine, Emergence agitation, Sevoflurane, Strabismus surgery

Resumo

Resumo Justificativa e objetivo: A agitação ao despertar é um comportamento pós-operatório negativo que afeta principalmente as crianças. Avaliamos o efeito de duas doses diferentes de dexmedetomidina na incidência e no grau de agitação ao despertar em crianças submetidas à correção de estrabismo. Métodos: Noventa pacientes foram alocados em três grupos iguais: receberam 0,5 µg.kg−1 de dexmedetomidina (grupo Dex-alta), 0,25 µg.kg−1 de dexmedetomidina (grupo Dex-baixa) ou solução salina normal (grupo placebo). Todos os medicamentos foram administrados com o fechamento da conjuntiva antes do fim da cirurgia. A escala pediátrica de delírio ao despertar da anestesia (PAED - Pediatric Anesthesia Emergence Delirium) foi usada para avaliar a agitação e a escala dos padrões de face, pernas, atividade, choro e consolabilidade (FLACC - Face, Legs, Activity, Cry, Consolability) para avaliar a dor. Os efeitos adversos de dexmedetomidina e os tempos de recuperação foram registrados. Resultados: A incidência de agitação foi significativamente menor no grupo Dex-alta em comparação com os outros grupos, foi significativamente menor no grupo Dex-baixa em comparação com o grupo placebo. A mediana (variação) do escore FLACC foi significativamente menor em ambos os grupos Dex em comparação com o grupo placebo. O tempo de recuperação, o tempo transcorrido desde a remoção da máscara laríngea até a abertura dos olhos e o tempo de permanência na sala de recuperação pós-anestesia foram significativamente maiores no grupo Dex-alta em comparação com os outros grupos. Não houve registro de bradicardia ou hipotensão significativa. O tempo de recuperação foi significativamente maior no grupo Dex-alta em comparação com os outros dois grupos. Conclusão: Dexmedetomidina (0,5 µg.kg−1) antes do despertar da anestesia geral resultou em uma redução da incidência de agitação ao despertar em comparação com dexmedetomidina (0,25 µg.kg−1), mas em detrimento dos tempos de recuperação sem efeitos adversos.

Palavras-chave

Crianças, Dexmedetomidina, Agitação ao despertar, Sevoflurano, Correção de estrabismo

References

Mountain BW, Smithson L, Cramolini M. Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium. AANA J. 2011;79:219-24.

Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement a clinical survey. Anesthesiology. 1961;22:667-73.

Keaney A, Diviney D, Harte S. Postoperative behavioral changes following anesthesia with sevoflurane. Pediatr Anesth. 2004;14:866-70.

Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96:1625-30.

Lapin SL, Auden SM, Goldsmith LJ. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Pediatr Anesth. 1999;9:299-304.

Kanaya A. Emergence agitation in children: risk factors, prevention, and treatment. J Anesth. 2016;30:261-7.

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.

Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138-45.

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89-91.

Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293-7.

McGoldrick K, Gayer S. Anesthesia and the eye. Clin Anesth. 2006;2:1095-112.

Aouad MT, Nasr VG. Emergence agitation in children: an update. Curr Opin Anesthesiol. 2005;18:614-9.

Dahmani S, Stany I, Brasher C. Pharmacological prevention of sevoflurane-and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216-23.

Gertler R, Brown HC, Mitchell DH. Dexmedetomidine: a novel sedative-analgesic agent. 2001.

Guo TZ, Jiang JY, Buttermann AE. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology. 1996;84:873-81.

Guler G, Akin A, Tosun Z. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Pediatric Anesth. 2005;15:762-6.

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

Sato M, Shirakami G, Tazuke-Nishimura M. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth. 2010;24:675-82.

Lili X, Jianjun S, Haiyan Z. The application of dexmedetomidine in children undergoing vitreoretinal surgery. J Anesth. 2012;26:556-61.

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

MacMillan LB, Hein L, Smith MS. Central hypotensive effects of the alpha2a-adrenergic receptor subtype. Science. 1996;273:801.

Penttilä J, Helminen A, Anttila M. Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects. Can J Physiol Pharmacol. 2004;82:359-62.

Ali MA, Abdellatif AA. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: a comparison of dexmedetomidine and propofol. Saudi J Anaesth. 2013;7:296-300.

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

5dcaf9580e88250f3003b87a rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections