Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery

Abstract

Purpose: To study the effects of dexmedetomidine (DEX), a selective α2-adrenoreceptor agonist, on emergence agitation (EA), recovery profiles, and parents' satisfaction after sevoflurane anesthesia in pediatric ambulatory surgery. Methods: In a double-blind trial, 81 children (ASA PS 1 or 2, 1-9 years) undergoing same-day or overnight-stay surgery were randomly assigned to receive intravenous DEX 0.3 μg kg-1 (n = 39) or saline (n = 42) over 10 min after induction of anesthesia. Anesthesia was induced and maintained with sevoflurane using a facemask or laryngeal mask airway with spontaneous respiration. Agitation was assessed with a 1-4 point scale and pain with a 0-10 point scale. The patients' parents were interviewed 24 h after surgery, and adverse events and the parents' level of satisfaction with perioperative care were recorded. Results: The incidence of EA (agitation scale score 3 or 4) was significantly lower in the DEX group (28%) than in the saline group (64%) (P = 0.0011). The mean pain scales in the DEX group were significantly lower than in the saline group during the stay in the post-anesthesia care unit (PACU) (P < 0.01). The incidence of adverse events, times to the first drinking and voiding in the PACU, time spent in the PACU, and parents' satisfaction level were not different between the two groups. Conclusion: Intravenous DEX at a dose of 0.3 μg kg-1 after induction of anesthesia reduced sevoflurane-associated EA and postoperative pain in pediatric ambulatory surgery, with no increase in the incidence of adverse events and with no change in parents' satisfaction level. © 2010 Japanese Society of Anesthesiologists.