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Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol
Adelais G Tsiotou1, Anna Malisiova1, Elena Kouptsova1
1Department of Anesthesiology, Children's Hospital "P. & A. Kyriakou", Athens, Greece.
Insights
Dexmedetomidine effectively reduced emergence delirium in children after tonsillectomy under propofol anesthesia. This treatment did not increase extubation time, offering a safer recovery for pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postanesthesia emergence delirium (PED) is a common complication following pediatric anesthesia, characterized by agitated behavior.
- Tonsillectomy with or without adenoidectomy is a frequent surgical procedure in children, often associated with PED.
- Propofol-based total intravenous anesthesia is frequently used for these procedures.
Purpose of the Study:
- To evaluate the efficacy of dexmedetomidine in preventing and reducing emergence delirium in pediatric patients undergoing tonsillectomy.
- To assess the impact of dexmedetomidine on secondary outcomes including delirium severity, extubation time, cardiovascular stability, and postoperative analgesia needs.
Main Methods:
- A prospective, single-center, double-blind, randomized controlled trial was conducted.
- Children aged 3-14 years, classified as ASA I or II, were randomized to receive either dexmedetomidine (1 mcg/kg) or a saline placebo.
- Emergence delirium and agitation severity were assessed using the Watcha scale at 10, 20, and 30 minutes post-anesthesia care unit arrival.
Main Results:
- Sixty children were included, with 31 receiving dexmedetomidine.
- The incidence of emergence delirium was significantly lower in the dexmedetomidine group at 20 (16.1% vs. 48.3%) and 30 minutes (12.9% vs. 41.4%) post-procedure.
- No significant differences were observed in anesthesia/surgery duration, blood pressure, or extubation time between the groups.
Conclusions:
- Dexmedetomidine at a dose of 1 mcg/kg significantly reduces the incidence and severity of emergence delirium in children undergoing tonsillectomy with propofol anesthesia.
- The administration of dexmedetomidine did not prolong the time to extubation.
- Dexmedetomidine is a safe and effective option for managing emergence delirium in this pediatric surgical population.
Background:
Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol.
Methods:
This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine. Secondary outcomes were emergence delirium severity, time to extubation, cardiovascular stability, and need for additional postoperative analgesia. Eligible were children 3-14 years of age, ASA I or II, scheduled for tonsillectomy with or without adenoidectomy. Patients were randomized to receive dexmedetomidine 1 mcg kg-1 or a volume matched normal saline solution. Presence of emergence delirium and agitation severity was assessed with the Watcha scale 10, 20, and 30 minutes after arrival in the postanesthesia care unit.
Results:
Sixty children participated to the study, 31 (51.7%) of them were treated with dexmedetomidine. Their mean age was 6.2 years (SD 5.5). Duration of anesthesia and surgery and blood pressure measurements did not differ between groups. Extubation time was not different between groups. The dexmedetomidine group had a significantly lower frequency of emergence delirium compared with no dexmedetomidine after 20 and 30 minutes in postanesthesia care unit: 16.1% and 12.9% at 20 and 30 minutes in the dexmedetomidine group vs 48.3% and 41.4% in in the no dexmedetomidine group.
Conclusion:
Dexmedetomidine 1 mcg kg-1 reduces the incidence and severity of emergence delirium after tonsillectomy with propofol anesthesia without prolonging the extubation time.
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