Yonsei Med J.  2014 Jan;55(1):209-215. 10.3349/ymj.2014.55.1.209.

Effect of Dexmedetomidine on Sevoflurane Requirements and Emergence Agitation in Children Undergoing Ambulatory Surgery

• Kim NY
• Kim SY
• Yoon HJ
• Kil HK

• KMID: 1779908
• DOI: http://doi.org/10.3349/ymj.2014.55.1.209

Abstract

PURPOSE
Dexmedetomidine, a potent selective alpha2-adrenergic agonist, produces sedation and analgesia. This study was conducted to assess the effect of dexmedetomidine infusion on sevoflurane requirements, recovery profiles, and emergence agitation in children undergoing ambulatory surgery.
MATERIALS AND METHODS
Forty children undergoing ambulatory hernioplasty or orchiopexy were randomized into two groups. The dexmedetomidine group (Group D, n=20) received dexmedetomidine 1 microg/kg, followed by 0.1 microg/kg/h until the end of surgery, whereas the saline group (Group S, n=20) received volume-matched normal saline. Sevoflurane was used for induction and maintenance of anesthesia and caudal block was performed in all children. End-tidal sevoflurane concentration (ET-sevo), the incidence of emergence agitation, pain scores, and sedation scores were recorded. Hemodynamic changes and other adverse effects were assessed in the perioperative period.
RESULTS
ET-sevo of Group D was significantly reduced in 23.8-67% compared to Group S during surgery. The incidence of emergence agitation was lower in Group D than in Group S (5% vs. 55%, p=0.001). Postoperative pain was comparable, and discharge time was not different between the groups. Mean arterial pressure and heart rate were significantly lower in Group D during surgery.
CONCLUSION
Intraoperative infusion of dexmedetomidine reduced sevoflurane requirements and decreased emergence agitation without delaying discharge in children undergoing ambulatory surgery. However, caution should be taken in regard to bradycardia and hypotension.

Keyword

Agitation; ambulatory surgery; dexmedetomidine; emergence; sevoflurane

MeSH Terms

Adolescent
Adult
Ambulatory Surgical Procedures/*methods
Child
Dexmedetomidine/*therapeutic use
Female
Hemodynamics/drug effects
Humans
Male
Methyl Ethers/*therapeutic use
Psychomotor Agitation/drug therapy
Young Adult
Dexmedetomidine
Methyl Ethers

Figure

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  Fig. 1 Flow chart representing patient assignment to study groups (randomized) and treatment protocols.

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  Fig. 2 End tidal-sevoflurane concentration during operation: Values are presented as mean±SD. *p<0.05 compared with Group S (Bonferroni-corrected). D, dexmedetomidine; S, saline; T0, just before dexmedetomidine administration; T1, just after dexmedetomidine loading; T2, 10 min after dexmedetomidine loading; T3, start of operation; T4, 10 min after the start of operation; T5, 20 min after the start of operation; T6, 30 min after the start of operation; T7, at the end of operation.

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  Fig. 3 Hemodynamic changes during operation. (A) Mean arterial pressure. (B) Heart rate. Values are presented as mean±SD. *p<0.05 compared with Group S (Bonferroni-corrected). D, dexmedetomidine; S, saline; T0, just before dexmedetomidine administration; T1, just after dexmedetomidine loading; T2, 10 min after dexmedetomidine loading; T3, start of operation; T4, 10 min after the start of operation; T5, 20 min after the start of operation; T6, 30 min after the start of operation; T7, at the end of operation.

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