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A prospective randomized controlled double-blind trial to assess the effects of dexmedetomidine during cleft palate
Priyanka Surana1, Devangi A Parikh1, Geeta A Patkar1
1Department of Anesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Mumbai, India.
Insights
Intraoperative dexmedetomidine significantly reduced hemodynamic stress in children undergoing cleft palate surgery. This anesthetic approach improved patient recovery and surgeon satisfaction while lowering medication needs.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Cleft palate (CP) surgery in children can trigger a significant sympathoadrenal response.
- Investigating methods to mitigate this surgical stress is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of intraoperative dexmedetomidine in attenuating the sympathoadrenal response during cleft palate surgery in children.
- To assess the impact of dexmedetomidine on hemodynamic stability, anesthetic requirements, and postoperative recovery.
Main Methods:
- A randomized controlled trial involving 60 children undergoing CP surgery.
- Patients received either standard anesthesia (control group) or anesthesia with dexmedetomidine.
- Hemodynamic parameters (heart rate, mean blood pressure), anesthetic agent consumption, recovery scores, agitation, pain, and analgesic requirements were monitored.
Main Results:
- Dexmedetomidine group showed significantly lower intraoperative heart rate and mean blood pressure compared to the control group.
- Anesthetic (fentanyl and isoflurane) requirements were reduced by 43% and 30% respectively in the dexmedetomidine group.
- Patients receiving dexmedetomidine experienced less emergence agitation, lower pain scores, and a delayed need for rescue analgesics, alongside improved surgeon satisfaction.
Conclusions:
- Intravenous dexmedetomidine effectively attenuates hemodynamic responses during cleft palate surgery in pediatric patients.
- The use of dexmedetomidine leads to improved patient recovery and high surgeon satisfaction.
- Close hemodynamic monitoring is recommended when administering dexmedetomidine in this surgical context.
Background:
We investigated whether the intraoperative administration of dexmedetomidine would attenuate the profound sympathoadrenal response associated with cleft palate (CP) surgery.
Methods:
Sixty children aged 6 months to 12 years undergoing CP surgery under general anesthesia were randomly assigned to the control (C) or dexmedetomidine (D) groups. Group C received benzodiazepine (0.05 mg/kg midazolam followed by infusion of normal saline) fentanyl isoflurane anesthesia, and Group D received dexmedetomidine (loading 1 µg/kg followed by infusion of 0.5 µg/kg/h) fentanyl isoflurane anesthesia. Heart rate (HR), mean blood pressure (MBP), intraoperative fentanyl and isoflurane requirements, recovery scores, emergence agitation, pain scores, time and requirement of rescue analgesic, and surgeon satisfaction were noted.
Results:
Intraoperative HR and MBP in Group D were significantly lower than the corresponding values in Group C (P < 0.001). HR decreased up to 16% in Group D. By contrast, HR increased up to 20% in Group C. Group D had comparable MBP to its baseline, whereas Group C had higher MBP until extubation (P = 0.015). Two children in Group D developed bradycardia and hypotension, which was successfully treated. The fentanyl and isoflurane requirements decreased by 43% and 30%, respectively, in Group D patients compared to those in Group C (P < 0.001). Group D had lower pain scores and less emergence agitation (P < 0.001). Time until requirement of first rescue analgesic was longer in Group D than that in Group C (P < 0.001). Surgeon satisfaction was higher in Group D than that in Group C.
Conclusions:
Intravenous dexmedetomidine during CP surgery attenuated hemodynamic responses with excellent surgeon satisfaction. Close monitoring of hemodynamics is recommended.
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