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Emergence agitation in pediatrics after dexmedetomidine vs. sevoflurane anesthesia: A randomized controlled trial

Corry Quando Yahya1,2,3, Hori Hariyanto1,2, Kohar Hari Santoso3

  • 1Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Pelita Harapan, Tangerang, Banten, Indonesia.

Plos One
|October 8, 2025
PubMed

Insights

Dexmedetomidine significantly reduces emergence agitation in pediatric patients undergoing cleft surgery. While recovery time was longer, the incidence of agitation was substantially lower compared to Sevoflurane anesthesia.

Area of Science:

  • Pediatric Anesthesia
  • Craniofacial Surgery
  • Pharmacology

Background:

  • Emergence agitation is a common issue in pediatric anesthesia, particularly after craniofacial surgeries like cleft repair.
  • High doses of opioids and inhalation anesthetics used in these procedures contribute to postoperative agitation.
  • Dexmedetomidine (DEX), an alpha-2 adrenoreceptor agonist, has demonstrated anxiolytic, sedative, and analgesic properties that may mitigate agitation.

Purpose of the Study:

  • To compare the incidence of emergence agitation between intravenous Dexmedetomidine (DEX) and Sevoflurane (SEVO) anesthesia in pediatric patients undergoing cleft lip or palate repair.
  • To evaluate the effects of DEX versus SEVO on extubation time and recovery time in this patient population.

Main Methods:

  • A randomized controlled study involving 121 pediatric patients (3 months to 10 years) with ASA 1-2 status undergoing elective cleft repair.
  • Patients were divided into two groups: Dexmedetomidine (n=59) and Sevoflurane (n=62).
  • Comparison of extubation time, recovery time, and emergence agitation using the Cravero scale.

Main Results:

  • No significant difference in extubation time was observed between the DEX and SEVO groups (p=0.317).
  • Recovery time was statistically longer in the DEX group (60 minutes) compared to the SEVO group (52 minutes) (p=0.007).
  • The incidence of emergence agitation was significantly lower in the DEX group (10%) compared to the SEVO group (82%) (p<0.001), with a higher Cravero score in the SEVO group (3.9 vs 2.5).

Conclusions:

  • Dexmedetomidine significantly reduces the incidence of emergence agitation in pediatric patients undergoing cleft lip and palate surgery.
  • The use of Dexmedetomidine does not prolong extubation time in this patient group.
  • While recovery time may be extended, the substantial reduction in emergence agitation makes Dexmedetomidine a favorable option.
Abstract

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