Yonsei Med J.  2014 Mar;55(2):508-516.

Low-Dose Dexmedetomidine Reduces Emergence Agitation after Desflurane Anaesthesia in Children Undergoing Strabismus Surgery

• Kim J
• Kim SY
• Lee JH
• Kang YR
• Koo BN

Abstract

PURPOSE
Emergence agitation (EA) is frequently observed in children undergoing general anaesthesia. This study tested whether the addition of an intra-operative low-dose infusion of dexmedetomidine to fentanyl treatment reduced the incidence of emergence delirium following desflurane anesthesia in children undergoing strabismus surgery.
MATERIALS AND METHODS
A total of 96 children (1-5 years old) undergoing strabismus surgery were enrolled. Anaesthesia was induced with propofol and maintained with desflurane. After induction, fentanyl (1 microg/kg) was administered to all children. During surgery, patients were infused with 0.2 microg/(kg.h)-1 dexmedetomidine (Group FD, n=47) or normal saline (Group F, n=47). Postoperative objective pain score (OPS), Paediatric Agitation and Emergence Delirium (PAED) score, and EA score were documented every 10 minutes in the post-anaesthesia care unit.
RESULTS
There were no significant differences between the two groups in demographic characteristics and haemodynamic changes. The mean values of maximum EA, maximum PAED, and maximum OPS score were significantly lower in Group FD than in Group F at 0, 10, and 20 minutes after arrival at the post-anaesthesia care unit (p<0.001). The frequency of fentanyl rescue was lower in Group FD than in Group F (p<0.001). The incidence of severe EA was significantly lower in Group FD than in Group F (12.8% vs. 74.5%, p<0.001).
CONCLUSION
Intra-operative low-dose infusion of dexmedetomidine in addition to fentanyl reduces EA following desflurane anaesthesia in children undergoing strabismus surgeries.

Keyword

Dexmedetomidine; emergence agitation; objective pain score; pediatrics

MeSH Terms

Anesthesia
Child*
Delirium
Dexmedetomidine*
Dihydroergotamine*
Fentanyl
Humans
Incidence
Methods
Pediatrics
Propofol
Strabismus*
Dexmedetomidine
Dihydroergotamine
Fentanyl
Propofol

Figure

• 

  Fig. 1 Postoperative emergence agitation and objective pain score in post-anesthesia care unit. (A) EA score, emergence agitation 5 point scale, (B) PAED score, Pediatric Anesthesia Emergence Delirium score and (C) objective pain scale. *p<0.05 compared with Group F. **p<0.01 compared with Group F. EA, emergence agitation.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve of PAED (A) and OPS score (B) for prediction of severe emergence agitation (EA≥4). Arrows indicate cut-off values. PAED, Paediatric Agitation Emergence Delirium; OPS, objective pain score.

• 

  Fig. 3 Intra-operative haemodynamic data. (A) Heart rate, (B) systolic blood pressure and (C) diastolic blood pressure.

• 

  Fig. 4 Intra-operative sequential comparison of the changes in the age-adjusted minimum alveolar concentration of desflurane (A) and the bispectral index (B) between the two groups. MAC, minimal alveolar concentration; BIS, bispectral index score.

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