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A Comparison of Dexmedetomidine and Propofol on Emergence Delirium in Children Undergoing Cleft Palate Surgery With

Lili Huang1,2, Li Wang1,2, Wei Peng1,2

  • 1The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education.

The Journal of Craniofacial Surgery
|November 5, 2021
PubMed

Insights

Dexmedetomidine significantly reduced emergence delirium in children after sevoflurane anesthesia for cleft palate surgery compared to propofol or saline. This sedative, analgesic, and sympatholytic agent offers a superior option for pediatric anesthesia.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Emergence delirium is a frequent complication following sevoflurane anesthesia, particularly impacting children undergoing cleft palate repair.
  • This condition can lead to adverse outcomes and complicate postoperative recovery in pediatric patients.
  • Identifying effective interventions to mitigate emergence delirium is crucial for improving patient safety and care.

Purpose of the Study:

  • To compare the efficacy of propofol versus dexmedetomidine in preventing emergence delirium in pediatric patients.
  • To evaluate the impact of these agents on pain scores and hemodynamic stability during emergence from anesthesia.
  • To determine the optimal anesthetic adjunct for reducing emergence delirium in children undergoing cleft palate surgery.

Main Methods:

  • Ninety pediatric patients (8-24 months) undergoing cleft palate repair were randomized into three groups: saline (control), propofol, or dexmedetomidine infusion.
  • Emergence delirium assessed using the Pediatric Anesthesia Emergence Delirium scale; pain evaluated with the Face, Legs, Activity, Cry, Consolability (FLACC) scale.
  • Hemodynamic parameters (heart rate, mean arterial pressure), respiratory recovery, extubation time, and adverse events were monitored.

Main Results:

  • Incidence of emergence delirium was significantly lower in the dexmedetomidine group (20.1%) compared to propofol (58.6%) and control (85.7%) groups (P < 0.05).
  • Dexmedetomidine group showed lower FLACC pain scores (3.9 ± 1.1) versus propofol (6.1 ± 0.9) and control (7.1 ± 1.0) groups (P < 0.05).
  • Patients receiving dexmedetomidine exhibited significantly lower heart rate and mean arterial pressure during emergence compared to the other groups (P < 0.05).

Conclusions:

  • Dexmedetomidine demonstrated superior efficacy in reducing the incidence and severity of emergence delirium in children undergoing cleft palate surgery under sevoflurane anesthesia.
  • The sedative, analgesic, and sympatholytic properties of dexmedetomidine contribute to improved postoperative outcomes and hemodynamic stability.
  • Dexmedetomidine is a valuable alternative to propofol for managing emergence delirium in this pediatric surgical population.

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