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Simonini A, Brogi E, Conti G, Vittori A, Cascella M, Calevo MG. Dexmedetomidine reduced the severity of emergence delirium and respiratory complications, but increased intraoperative hypotension in children underwent tonsillectomy: a retrospective analysis. Minerva Pediatr (Torino) 2024; 76:574-581. [PMID: 34515441 DOI: 10.23736/s2724-5276.21.06330-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intraoperative dexmedetomidine can be useful for its sedative and analgesic sparing effects, and for the prevention of emergence delirium. Conversely, it can cause hypotension and bradycardia. The aim of this study was to assess the safety and efficacy of dexmedetomidine in pediatric anesthesia. METHODS This is a retrospective cohort study in children who received intravenous dexmedetomidine (Dex group) or opioids (No-Dex group) during general anesthesia for tonsillectomy, between November 2014 and November 2016. From the medical records, data on the intraoperative phase (hemodynamic adverse events, respiratory failure at the emergence, awakening and extubation times, emergence delirium), recovery room (pain, hemodynamic parameters, and desaturation), and ward stay (pain, and nausea and vomiting) were investigated. Time of hospital discharge was calculated. RESULTS Three hundred twenty-eight (Dex group 183; No-Dex group 145) children ranging from 1.5 to 10 years were included. The percentage of intraoperative hypotension was significantly higher in the Dex group (P=0.01). The extubation times were significantly higher in No-Dex group (P=0.0001), although the awakening times were significantly longer with dexmedetomidine (P=0.0001). Desaturation episodes were higher in the Dex group (P=0.0001). The incidence of emergence delirium was similar in the two groups, but of greater intensity in the No-Dex group. While in the immediate postoperative period there was no difference in pain, after 24 hours, the incidence of pain and vomiting was significantly higher (P=0.003; P=0.0001) in the No-Dex group. CONCLUSIONS Although several outcome parameters showed important advantages of dexmedetomidine over opioid-based regimens in terms of safety and efficacy, issues such as the increased intraoperative hypotension, indicated that it is not possible to draw any definitive conclusions.
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Affiliation(s)
- Alessandro Simonini
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy -
| | - Etrusca Brogi
- Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pedriatrico Bambino Gesù IRCCS, Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori IRCCS Pascale Foundation, Naples, Italy
| | - Maria G Calevo
- Unit of Epidemiology and Biostatistics, IRCCS Giannina Gaslini Institute, Genoa, Italy
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Zheng L, Fang T, Zhang W, Zhang X, Ren Z, Qin W, Liang W, Ma Q, Yin N. Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial. Drug Des Devel Ther 2024; 18:443-452. [PMID: 38370564 PMCID: PMC10874235 DOI: 10.2147/dddt.s452077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Dexmedetomidine (Dex) is a potent and highly selective α2-adrenergic receptor agonist. Within an appropriate dose range, Dex can effectively attenuate the surgical stress response, provide intraoperative hemodynamic stability, and improve the patient recovery quality. High-dose Dex can delay patient awakening from anesthesia and increase the incidence of bradycardia. This randomized controlled trial aimed to investigate the effects of low-dose intravenous Dex premedication in patients undergoing laparoscopic cholecystectomy (LC). Material and Methods In total, 100 patients undergoing LC were equally randomized into Group C (premedication with saline) and Group D (premedication with 0.5 µg/kg Dex). The patients were premedicated with saline or Dex, depending on the group, before anesthesia induction. Following this, anesthesia induction and endotracheal intubation was performed, and anesthesia was maintained during surgery. Following the completion of the surgery, the patients were transferred the post-anesthesia care unit (PACU) and stayed there until they met the PACU discharge criteria. The hemodynamic parameters, consumption of anesthetics, surgical duration, postoperative awakening time, extubation time, postoperative pain, and complications were recorded. Results No significant differences were observed in the heart rate (HR) and mean arterial pressure (MAP) between the two groups before premedication (P>0.05). The MAP and HR immediately after endotracheal intubation and immediately after extubation were significantly lower in Group D than in Group C (P<0.05 for both). The incidence of bradycardia was significantly higher in Group D than in Group C (P<0.05), while atropine was used in neither group. Propofol and remifentanil consumption was significantly lower in Group D than in Group C (P<0.05). The postoperative awakening and extubation times were significantly shorter in Group D than in Group C (P<0.05). The postoperative visual analog scale scores for pain and incidence of nausea, vomiting, and cough were significantly lower in Group D than in Group C (P<0.05 for all). Conclusion Our data suggest that premedication with dexmedetomidine (0.5 µg/kg) before general anesthesia induction can effectively attenuate intraoperative stress response and postoperative pain, maintain perioperative hemodynamic stability, and decrease the incidence of adverse events, which might be an effective and safe anesthetic protocol during LC worthy of further clinical application.
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Affiliation(s)
- Longbin Zheng
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Tao Fang
- Department of Anesthesiology, Xinchang County People’s Hospital, Xinchang, Zhejiang Province, People’s Republic of China
| | - Wei Zhang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xiaojing Zhang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Zhiqiang Ren
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Weimin Qin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Wenbo Liang
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Qing Ma
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Ning Yin
- Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
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López Segura M, Busto-Aguirreurreta N. Postoperative agitation or delirium in paediatric patients. What we know and how to avoid it. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:467-472. [PMID: 37678453 DOI: 10.1016/j.redare.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/10/2022] [Indexed: 09/09/2023]
Abstract
Emergence delirium or postoperative agitation is the name given to the state of altered consciousness that occurs after surgery and especially affects pediatric patients. Its incidence is not negligible, reaching 80% of cases in certain studies. It is frequently confused with other clinical entities, for which reason a scale has been validated to facilitate its diagnosis. Risk factors include age under 5 years, the presence of pain after surgery and especially intense preoperative anxiety. Pediatric emergence delirium presents as an adverse event after surgery and influences patient safety by significantly increasing patient comorbidity. It is essential to recognize the entity, as well as its risk factors, in order to apply effective preventive measures to reduce its incidence and intensity when it occurs.
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Affiliation(s)
- M López Segura
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - N Busto-Aguirreurreta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario de Navarra, Pamplona, Spain
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Wang CM, Zhang Y, Chen WC, Lin S, He HF. Effects of Pharmacological Intervention on Recovery After Sevoflurane Anesthesia in Children: a Network Meta-analysis of Randomized Controlled Trials. Mol Neurobiol 2023; 60:4488-4501. [PMID: 37115403 DOI: 10.1007/s12035-023-03349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Sevoflurane, commonly administered to children as anesthesia, often leads to emergence delirium (ED). Currently, a consensus is lacking among clinicians regarding pharmacological interventions to improve recovery. To determine an effective approach, we compared the effects of several drugs in lowering the incidence of ED after sevoflurane anesthesia in children.We searched online databases for relevant randomized controlled trials (59 studies selected; 5199 NMA-eligible participants) and performed a frequentist network meta-analysis (NMA). This study was registered on PROSPERO (number CRD: 42022329939).All included studies had a low to moderate risk of overall bias. The incidence of ED after sevoflurane anesthesia in children differed according to other drugs administered, and were ranked from high to low according to the surface under the cumulative ranking curve (SUCRA).Sufentanil (91.2%) and dexmedetomidine (77.6%) were more likely to reduce the incidence (SUCRA value) of ED, whereas the placebo (6.5%), ramelteon (11.1%), and magnesium (18%) were less likely to reduce the incidence of ED. Remifentanil (89.3%) ranked first in shortening emergence time, followed by placebo (82.4%) and ketamine (69.7%). Placebo shortened extubation time, followed by remifentanil (66.5%) and alfentanil (61.4%).Sufentanil and remifentanil lowered sevoflurane-induced ED incidences among children and shortened the emergence time more effectively than other drugs. Most adjuvant drugs that are combined with sevoflurane either do not change or may even prolong extubation time. Further research and clinical trials are required to support and update these conclusions.
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Affiliation(s)
- Cong-Mei Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
- Department of Anesthesiology, Shishi General Hospital, NO.2156 Shijin Road, Shishi, 362700, Fujian Province, China
| | - Yan Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Wei-Can Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
- Neuroendocrinology Group, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia.
| | - He-Fan He
- Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
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Challa C, Geng-Ramos G, Gray L, Orshan T, Thackeray L, Gupta P. Anxiety in children: A review on how to address it in the perioperative setting post-pandemic. Paediatr Anaesth 2023; 33:422-426. [PMID: 36876996 DOI: 10.1111/pan.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/22/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
In this paper, we review the psychological burden of SARS-CoV-2 on children and how health care workers can play a role in mitigating its mental health impact during anesthetic procedures. We evaluate the societal changes that have affected children over 2 years of the pandemic and the subsequent soaring rates of anxiety and depression reported. Unfortunately, the perioperative setting is a stressful experience at baseline and the addition of COVID-19 has only exacerbated the situation. Anxiety and depression are often linked to maladaptive behavior post-surgery, including increased rates of emergence delirium. Providers can utilize techniques based on developmental milestones, Certified Child Life Specialists, parental presence during induction, and medications to reduce anxiety. As health care workers, we need to recognize and address these concerns as untreated mental health issues can leave long-term consequences for children.
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Affiliation(s)
- Chaitanya Challa
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Giuliana Geng-Ramos
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Laura Gray
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Taytum Orshan
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Laura Thackeray
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Pooja Gupta
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
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Zhang J, Yin J, Li Y, Zhang Y, Bai Y, Yang H. Effect of dexmedetomidine on preventing perioperative respiratory adverse events in children: A systematic review and meta‑analysis of randomized controlled trials. Exp Ther Med 2023; 25:286. [PMID: 37206556 PMCID: PMC10189613 DOI: 10.3892/etm.2023.11985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/15/2023] [Indexed: 05/21/2023] Open
Abstract
The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAEs). The present meta-analysis aimed to assess the preventive effect of dexmedetomidine on PRAEs in children. Dexmedetomidine is a highly selective α2-adrenoceptor agonist that provides sedation, anxiolysis and analgesic effects without causing respiratory depression. Dexmedetomidine can diminish airway and circulatory responses during extubation in children. Original randomized controlled trial data were analyzed to study the putative effect of dexmedetomidine on PRAEs. By searched the Cochrane Library, EMBASE and PubMed, a total of ten randomized controlled trials (1,056 patients) was identified. PRAEs included cough, breath holding, laryngospasm, bronchospasm, desaturation (percutaneous oxygen saturation <95%), body movement and pulmonary rales. Compared with placebo, dexmedetomidine resulted in a significant reduction of incidence of cough, breath holding, laryngospasm and emergence agitation. The incidence of PRAEs was significantly reduced in dexmedetomidine compared with active comparators group. Moreover, dexmedetomidine decreased heart rate and increased post-anesthesia care unit stay duration by 11.18 min. The present analysis suggested that dexmedetomidine improved the airway function and decreased risks associated with general anesthesia in children. The present data demonstrated that dexmedetomidine may be a good choice to prevent PRAEs in children.
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Affiliation(s)
- Junli Zhang
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
- Correspondence to: Miss Junli Zhang or Dr Hongyuan Yang, Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, 1 Hetai Road, Lunan, Tangshan, Hebei 063000, P.R. China
| | - Jing Yin
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
| | - Yuanyuan Li
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
| | - Yu Zhang
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
| | - Yaowu Bai
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
| | - Hongyuan Yang
- Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, Tangshan, Hebei 063000, P.R. China
- Correspondence to: Miss Junli Zhang or Dr Hongyuan Yang, Department of Anesthesiology, Tangshan Maternal and Child Health Care Hospital, 1 Hetai Road, Lunan, Tangshan, Hebei 063000, P.R. China
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Wang K, Cai J, Du R, Wu J. Global trends in research related to emergence delirium, 2012–2021: A bibliometric analysis. Front Psychol 2023; 14:1098020. [PMID: 36968713 PMCID: PMC10031052 DOI: 10.3389/fpsyg.2023.1098020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
IntroductionEmergence delirium is a kind of mental disorder during the early awakening period after general anesthesia, which is manifested as the combination of perceptual disturbance and psychomotor agitation. It is an independent risk factor for postoperative delirium and even long-term postoperative cognitive decline, which often affects the postoperative outcome and deserves the attention of clinical anesthesiologists. There are many studies on emergence delirium, but the quantity and quality of these studies are unclear. Therefore, we conducted a bibliometric analysis of studies on emergence delirium between January 2012 and December 2021. Through the analysis of relevant literature, the research hotspots and trends of emergence delirium are understood, which can provide a reference for future research.MethodsWe searched the Web of Science Core Collection (WoSCC) for original articles and reviews related to emergence delirium published between 2012 and 2021, and collected a variety of bibliographic elements, including annual publications, authors, countries/regions, institutions, journals, and keywords. Three different science-based tools (CiteSpace, VOSviewer and Bibliometrix) were used for this comprehensive analysis.ResultsFrom January 2012 to December 2021, a total of 912 emergence delirium (ED) related literature were published, including 766 original research articles and 146 review articles. The number of publications has increased every year except 2016. The United States published 203 articles, ranking first with China, followed by South Korea (95 articles). The United States is also the country with the most citations (4,508), and Yonsei Univ is the most productive institution. The most published journal was PEDIATRIC ANESTHESIA, with the highest h and g index. LEE JH is the most influential author in this field.Discussion“Children, emergence agitation, delirium, dexmedetomidine” are the hot topics in this field in recent years. The bibliometric analysis in this field will provide the future direction for the study of emergence delirium for clinicians.
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Affiliation(s)
- Kenru Wang
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiehui Cai
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Jiehui Cai,
| | - Ruiming Du
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Ruiming Du,
| | - Jiaxuan Wu
- Department of Anesthesia, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Jiaxuan Wu,
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Vitale L, Rodriguez B, Baetzel A, Christensen R, Haydar B. Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database. BMC Anesthesiol 2022; 22:223. [PMID: 35840903 PMCID: PMC9284878 DOI: 10.1186/s12871-022-01767-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies examining removal of endotracheal tubes and supraglottic devices under deep anesthesia were underpowered to identify rare complications. This study sought to report all adverse events associated with this practice found in a large national database of pediatric anesthesia adverse events. Methods An extract of an adverse events database created by the Wake Up Safe database, a multi-institutional pediatric anesthesia quality improvement initiative, was performed for this study. It was screened to identify anesthetics with variables indicating removal of airway devices under deep anesthesia. Three anesthesiologists screened the data to identify events where this practice possibly contributed to the event. Event data was extracted and collated. Results One hundred two events met screening criteria and 66 met inclusion criteria. Two cardiac etiology events were identified, one of which resulted in the patient’s demise. The remaining 97% of events were respiratory in nature (64 events), including airway obstruction, laryngospasm, bronchospasm and aspiration. Some respiratory events consisted of multiple distinct events in series. Nineteen respiratory events resulted in cardiac arrest (29.7%) of which 15 (78.9%) were deemed preventable by local anesthesiologists performing independent review. Respiratory events resulted in intensive care unit admission (37.5%), prolonged intubation and temporary neurologic injury but no permanent harm. Provider and patient factors were root causes in most events. Upon investigation, areas for improvement identified included improving patient selection, ensuring monitoring, availability of intravenous access, and access to emergency drugs and equipment until emergence. Conclusions Serious adverse events have been associated with this practice, but no respiratory events were associated with long-term harm.
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Affiliation(s)
- Lisa Vitale
- Department of Pediatric Anesthesia, University of Michigan, Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA. .,4-917 Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA.
| | - Briana Rodriguez
- Department of Pediatric Anesthesia, University of Michigan, Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA.,US Anesthesia Partners Texas - South, P.O. Box 701090, San Antonio, TX, 78270, USA
| | - Anne Baetzel
- Department of Pediatric Anesthesia, University of Michigan, Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA.,4-951 Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA
| | - Robert Christensen
- Department of Pediatric Anesthesia, University of Michigan, Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA.,4-914 Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA
| | - Bishr Haydar
- Department of Pediatric Anesthesia, University of Michigan, Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA.,4-911 Mott Hospital, 1540 E Hospital Dr SPC 4245, Ann Arbor, MI, 48109-4245, USA
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Yi W, Li J, Zhuang Y, Wan L, Li W, Jia J. The effect of two different doses of dexmedetomidine to prevent emergence agitation in children undergoing adenotonsillectomy: a randomized controlled trial. Braz J Anesthesiol 2021; 72:63-68. [PMID: 34627829 PMCID: PMC9373663 DOI: 10.1016/j.bjane.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 08/01/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate different doses of dexmedetomidine for the prevention of emergence agitation in children undergoing adenotonsillectomy. Method One hundred and thirty children aged 3–10 years scheduled for adenotonsillectomy were randomly assigned to two groups. Anesthesia was induced with 0.5 μg.kg-1 dexmedetomidine (DEX 0.5 group) or 1 μg.kg-1 dexmedetomidine (DEX 1 group) at the beginning of surgery. Observers who recorded the data in the postanesthesia care unit were blinded to the allocation. The primary outcome was the percentage of emergence agitation. The times to spontaneous breath, awake, extubate, and postanesthesia care unit stay were also recorded. Results One hundred twenty four children were randomized into two groups. Five children were excluded because of adverse events and dropout (DEX 0.5 group, n = 58; DEX 1 group, n = 62). No significant differences were noted in the percentage of emergence agitation between the two groups. The times to extubation (p = 0.003), awake, and postanesthesia care unit stay in DEX 0.5 group were shorter than those in DEX 1 group (p < 0.0001). There was no significant difference between the two groups in the time to spontaneous breath. Approximately 8% of patients in DEX 0.5 group and 18% patients in DEX 1 group presented low SpO2, showing a significant difference between the two groups (p = 0.043). Conclusions A dose of 0.5 μg.kg-1 dexmedetomidine was equally effective as 1 μg.kg-1 dexmedetomidine in preventing emergence agitation. Trial registration : The trial is currently completed recruitment, registered in ClinicalTrials.gov (ID:NCT03760809). Inclusion began on 4 January, 2019.
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Affiliation(s)
- Wenjing Yi
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China
| | - Jie Li
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China
| | - Yan Zhuang
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China
| | - Lichun Wan
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China
| | - Wenxian Li
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China
| | - Jie Jia
- Fudan University, Eye, Ear, Nose & Throat Hospital, Department of Anesthesiology, Shanghai, China.
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Wang HY, Chen TY, Li DJ, Lin PY, Su KP, Chiang MH, Carvalho AF, Stubbs B, Tu YK, Wu YC, Roerecke M, Smith L, Tseng PT, Hung KC. Association of pharmacological prophylaxis with the risk of pediatric emergence delirium after sevoflurane anesthesia: An updated network meta-analysis. J Clin Anesth 2021; 75:110488. [PMID: 34481361 DOI: 10.1016/j.jclinane.2021.110488] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE This updated network meta-analysis aims at exploring whether the concurrent use of midazolam or antiemetics may enhance the efficacy of other pharmacological regimens for delirium prophylaxis in pediatric population after general anesthesia (GA). DESIGN Network meta-analysis (PROSPERO registration: CRD42020179483). SETTING Postoperative recovery area. PATIENTS Pediatric patients undergoing GA with sevoflurane. INTERVENTIONS Pharmacological interventions applied during GA with sevoflurane. MEASUREMENTS This network meta-analysis of randomized controlled trials (RCTs) was conducted with a frequentist model. PubMed, Embase, ProQuest, ScienceDirect, Cochrane CENTRAL, ClinicalKey, Web of Science, and ClinicalTrials.gov were searched from their inception dates to April 12, 2020, for RCTs of either placebo-controlled or active-controlled design containing information on the incidence of emergence delirium in pediatric patients undergoing sevoflurane anesthesia. MAIN RESULTS Seventy studies comprising 6904 participants were included for the analysis of 30 pharmacological interventions. Based on surface under the cumulative ranking curve (SUCRA) analysis, midazolam was ranked the lowest in therapeutic effect (SUCRA: 20%), while antiemetics as a monotherapy had no effect on delirium prophylaxis. However, there was a trend that most combination therapies with midazolam or antiemetics were superior to monotherapies for delirium prophylaxis. Subgroup analyses based on age (i.e., ≤7 years) and a validated scoring system (i.e., the Pediatric Anesthesia Emergence Delirium scale) for delirium also suggested a better efficacy of combination therapies than monotherapies. Overall, combination therapies with midazolam or antiemetics did not have a negative impact on the incidence of postoperative nausea and vomiting, length of stay in the postanesthesia care unit, or time to extubation. The dexmedetomidine-midazolam-antiemetic combination was the most effective strategy for the prevention of emergence delirium. CONCLUSIONS This network meta-analysis suggested that the incorporation of midazolam or antiemetics as adjuncts for combination therapies may have synergistic effects against pediatric postoperative emergence delirium. Future large-scale placebo-controlled RCTs are warranted to validate our findings.
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Affiliation(s)
- Hung-Yu Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Min-Hsien Chiang
- Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Michael Roerecke
- Independent Scientist, Institute for Mental Health Policy Research, PAHO/WHO Collaborating Centre for Addiction and Mental Health, Centre for Addiction and Mental Health (CAMH), Dalla Lana School of Public Health (DLSPH), University of Toronto, Canada
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
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11
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Dexmedetomidine: What's New for Pediatrics? A Narrative Review. J Clin Med 2020; 9:jcm9092724. [PMID: 32846947 PMCID: PMC7565844 DOI: 10.3390/jcm9092724] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.
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12
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Urits I, Peck J, Giacomazzi S, Patel R, Wolf J, Mathew D, Schwartz R, Kassem H, Urman RD, Kaye AD, Viswanath O. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther 2020; 37:1897-1909. [PMID: 32274749 DOI: 10.1007/s12325-020-01317-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively non-pharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Jacquelin Peck
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Stephen Giacomazzi
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Riki Patel
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - John Wolf
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Denzil Mathew
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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13
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Du Z, Zhang X, Qu S, Song Z, Wei S, Xiang Z, Guo Q. The comparison of dexmedetomidine and midazolam premedication on postoperative anxiety in children for hernia repair surgery: A randomized controlled trial. Paediatr Anaesth 2019; 29:843-849. [PMID: 31125470 PMCID: PMC6852055 DOI: 10.1111/pan.13667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 05/07/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative anxiety is common in pediatric patients undergoing surgery. AIMS The aim of this study was to determine whether an infusion of dexmedetomidine prior to hernia repair in children provides better postoperative anxiety outcomes that a preoperative infusion of midazolam. METHODS Ninety 6-11-year-old children, who were scheduled to undergo elective hernia repair, were enrolled for this double-blind, randomized controlled trial. Group D (n = 45) received an intravenous infusion of dexmedetomidine (0.5 μg/kg) and Group M (n = 45) received an intravenous infusion of midazolam (0.08 mg/kg) in 20 mL of normal saline for 10 minutes before the induction of anesthesia. Pre- and postoperative scores on the modified Yale Preoperative Anxiety Scale were the main outcomes. Secondary outcomes included systolic blood pressure, diastolic blood pressure, heart rate, and postoperative pain measured on a visual analogue scale and patient satisfaction using a numerical rating scale. RESULTS Postoperative anxiety in Group D was significantly lower than preoperative anxiety (2 hours postoperatively mean difference [95% CI]: 2.83 [0.87-4.79], P = 0.036, 4 hours postoperatively mean difference [95% CI]: 3.29 [1.39-5.20], P = 0.005). Preoperative and postoperative anxiety in Group M was similar. Anxiety scores in Group D were also significantly lower than anxiety in Group M 2 hours (mean difference [95% CI]: 1.89 [0.52-3.26], P = 0.01) and 4 hours (mean difference [95% CI]: 3.32 [1.98-4.66], P < 0.001) postoperatively. Systolic blood pressure, diastolic blood pressure and heart rate were lower in Group D than in Group M after administration of sedative drugs until children left PACU (SBP mean difference [95% CI]: 13.87 [10.30-17.43], P < 0.001, DBP mean difference [95% CI]: 5.96[3.80-8.11], P < 0.001, HR mean difference [95% CI]: 10.36 [7.58-13.13], P < 0.001). Pain was also significantly lower in Group D than in Group M at 2 hours (median difference [95% CI]: 1 [0.26-1.34], P = 0.004), 4 hours (median difference [95% CI]: 1 [0.31-1.02], P = 0.003), and 1 day (median difference [95% CI]: 0 [0.22-0.76], P = 0.003) postoperatively. Patient satisfaction scores were significantly higher in Group D than in Group M 1 day (median difference [95% CI]: 0 [-0.83 to -0.24], P = 0.006) and somewhat higher 1 week (median difference [95% CI]: 0 [-0.67 to -0.04], P = 0.06) postoperatively. CONCLUSION Compared with midazolam, a single preoperative intravenous dose of dexmedetomidine appears to provide better postoperative anxiolytic effects for children undergoing same-day surgery.
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Affiliation(s)
- Zhen Du
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
| | - Xi‐Ying Zhang
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Shuang‐Quan Qu
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Zong‐Bing Song
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
| | - Si‐Wei Wei
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Zhen Xiang
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Qu‐Lian Guo
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
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14
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Lopez MM, Zech D, Linton JL, Blackwell SJ. Dexmedetomidine Decreases Postoperative Pain and Narcotic Use in Children Undergoing Alveolar Bone Graft Surgery. Cleft Palate Craniofac J 2018; 55:688-691. [DOI: 10.1177/1055665618754949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: Dexmedetomidine is a parenteral agent that combines the benefits of cooperative sedation, anxiolysis, and analgesia without the risks of respiratory depression. Off-label use has been reported in children. We have introduced dexmedetomidine for use in patients having undergone alveolar bone graft (ABG). The objective is to demonstrate the value and safety of postoperative dexmedetomidine infusion in a non-ICU setting following ABG. Design: A retrospective review was performed on patients who underwent ABG by the senior author. Patients were divided into 2 groups: those who received postoperative dexmedetomidine and those who received patient-controlled anesthesia. Main Outcome Measure(s): The primary study outcome measures included patient demographics, adverse events, length of stay, pain scores, and doses of narcotics during admission were collected. Results: Inclusion criteria were met by 54 patients; 39 received dexmedetomidine whereas 15 did not. There were no significant differences between groups in age, gender, and length of stay. The patients who received dexmedetomidine used oral narcotics less often ( P = .01). In addition, more patients reported no pain after surgery ( P = .05) and at the time of discharge if they received dexmedetomidine ( P < .01). There were no reported adverse effects. Conclusions: Dexmedetomidine provided superior pain control after surgery and at the time of discharge, as well as a significant decrease in the use of oral narcotics. In our institution, it has since replaced the PCA as a postoperative pain control modality. Absent the risk for respiratory depression, dexmedetomidine has demonstrated a safe option for postoperative pain control in our focused group of pediatric patients.
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Affiliation(s)
- Mariela M. Lopez
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Derrick Zech
- Department of Oral and Maxillofacial Surgery, Health Science Center, University of Texas Houston, Houston, TX, USA
| | - Judith L. Linton
- Department of Plastic Surgery, Shriners Hospitals for Children-Houston, Houston, TX, USA
| | - Steven J. Blackwell
- Department of Plastic Surgery, Shriners Hospitals for Children-Houston, Houston, TX, USA
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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15
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Çolak A, Yılmaz E, Kıray BK. Sugammadex-Induced Hypersensitivity Reaction in a Pediatric Patient. Turk J Anaesthesiol Reanim 2018; 46:66-68. [PMID: 30140504 DOI: 10.5152/tjar.2018.04696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022] Open
Abstract
We report a case of a 3-year-old boy who administered sugammadex and developed an allergic reaction several minutes after the administration. He developed an increase in airway pressures and a decrease in peripheral oxygen saturation; auscultation revealed widespread wheezing in the lungs. He was successfully treated with immediate administration of methylprednisolone, pheniramine, and theophylline. We assumed an allergic reaction to sugammadex based on the clinical condition of the patient.
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Affiliation(s)
- Alkin Çolak
- Department of Anaesthesiology, Trakya University School of Medicine, Edirne, Turkey
| | - Elif Yılmaz
- Department of Anaesthesiology, Edirne Sultan I. Murat Government Hospital, Edirne, Turkey
| | - Büşra Küçük Kıray
- Department of Anaesthesiology, Trakya University School of Medicine, Edirne, Turkey
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16
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Di M, Yang Z, Qi D, Lai H, Wu J, Liu H, Ye X, ShangGuan W, Lian Q, Li J. Intravenous dexmedetomidine pre-medication reduces the required minimum alveolar concentration of sevoflurane for smooth tracheal extubation in anesthetized children: a randomized clinical trial. BMC Anesthesiol 2018; 18:9. [PMID: 29343232 PMCID: PMC5773144 DOI: 10.1186/s12871-018-0469-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background It has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal extubation (MACEX) in anesthetized children. Methods A total of seventy-five pediatric patients, aged 3–7 years, ASA physical status I and II, and undergoing tonsillectomy were randomized to receive intravenous saline (Group D0), dexmedetomidine 1 μg∙kg−1 (Group D1), or dexmedetomidine 2 μg∙kg−1 (Group D2) approximately 10 min before anesthesia start. Sevoflurane was used for anesthesia induction and anesthesia maintenance. At the end of surgery, the initial concentration of sevoflurane for smooth tracheal extubation was determined according to the modified Dixon’s “up-and-down” method. The starting sevoflurane for the first patient was 1.5% in Group D0, 1.0% in Group D1, and 0.8% in Group D2, with subsequent 0.1% up or down in next patient based on whether smooth extubation had been achieved or not in current patient. The endotreacheal tube was removed after the predetermined concentration had been maintained constant for ten minutes. All responses (“smooth” or “not smooth”) to tracheal extubation and respiratory complications were assessed. Results MACEX values of sevoflurane in Group D2 (0.51 ± 0.13%) was significantly lower than in Group D1 (0.83 ± 0.10%; P < 0.001), the latter being significantly lower than in Group D0 (1.40 ± 0.12%; P < 0.001). EC95 values of sevoflurane were 0.83%, 1.07%, and 1.73% in Group D2, Group D1, and Group D0, respectively. No patient in the current study had laryngospasm. Conclusion Dexmedetomidine decreased the required MACEX values of sevoflurane to achieve smooth extubation in a dose-dependent manner. Intravenous dexmedetomidine 1 μg∙kg−1 and 2 μg∙kg−1 pre-medication decreased MACEX by 41% and 64%, respectively. Trial registration Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOD-17011601, date of registration: 09 Jun 2017, retrospectively registered.
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Affiliation(s)
- Meiqin Di
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Zhuqing Yang
- Department of Anesthesiology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, Zhejiang Province, People's Republic of China
| | - Dansi Qi
- Department of Pathology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China
| | - Hongyan Lai
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Junzheng Wu
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Huacheng Liu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Xuefei Ye
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Wangning ShangGuan
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Qingquan Lian
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Jun Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China.
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Sharma R, Dwivedi D, Choudhary R. Anesthesia challenges for emergency surgery in a pediatric patient with congenital laryngomalacia. Saudi J Anaesth 2018; 12:500-502. [PMID: 30100863 PMCID: PMC6044159 DOI: 10.4103/sja.sja_199_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ridhima Sharma
- Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdurjung Hospital, New Delhi, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ripon Choudhary
- Department of Anaesthesia and Critical Care, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India
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18
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Cho HK, Yoon HY, Jin HJ, Hwang SH. Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis. Laryngoscope 2017; 128:E184-E193. [PMID: 28895149 DOI: 10.1002/lary.26888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to assess the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children. DATA SOURCE Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception of article collections to April 2017. REVIEW METHODS Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were systemically and independently reviewed by two researchers. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities (nausea and vomiting and agitation). RESULTS Fifteen studies with n = 1,552 met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group than in the control group. Additionally, there was no significant difference in the duration of staying PACU between both groups. In subgroup analyses by administration method (bolus injection or continuous injection), dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method. CONCLUSION Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy. Considering the high heterogeneity of results within some parameters; however, further clinical trials with robust research methodology should be conducted to confirm the results of this study. Laryngoscope, 128:E184-E193, 2018.
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Affiliation(s)
- Hye Kyung Cho
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon
| | - Ho Young Yoon
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jun Jin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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