Intraoperative use of dexmedetomidine does not significantly affect post-operative agitation in children under 12 years of age, according to results of a single-centre, retrospective study presented at the 2014 Annual Meeting of the American Society of Anesthesiologists (ASA).
Post-operative (or emergence) agitation refers to restlessness, disorientation, crying, delusions, and non-purposeful thrashing movements that occur after general anaesthesia in up to 80% of children. Emergence agitation can cause patient self-injury and parental anxiety, as well as increased costs involving post-operative nursing care and delayed hospital discharge, stated lead author Daniel Moy, MD, Georgetown University School of Medicine, Washington, DC.
Dexmedetomidine is a common sedative agent administered as prophylaxis before the end of inhalational anaesthesia to prevent emergence agitation, Dr. Moy explained here at a poster session on October 11.
The research team evaluated data obtained from 42 charts of patients less than 12 years old, all of whom were classified as ASA 1 and 2 (patients in normal health and patients with mild systemic disease, respectively), who had undergone tonsillectomy and adenoidectomy. The patients were divided into 3 groups according to whether they had received intra-operative narcotic alone, narcotic with 0.5 mcg/kg dexmedetomidine, or narcotic with 1 mcg/kg dexmedetomidine.
There were no statistically significant differences in emergence agitation or post-operative discharge times among the patients who were administered intraoperative dexmedetomidine.
The team used regression analysis to evaluate the dexmedetomidine dose based on the total time spent in the post-anaesthesia recovery unit (PACU), and based on scores from the Modified Richmond Agitation Sedation Scale (mRASS) at 0, 15, and 30 minutes from PACU admission. mRASS scoring for this trial was on a scale of 0 to 9, with 5 representing “alert and calm,” and higher scores indicating greater agitation. The average mRASS scores at PACU admission for the 0-mcg/kg, 0.5-mcg/kg, and 1-mcg/kg doses of intraoperative dexmedetomidine, were 3.07, 2.53, and 2.92, respectively. Scores were similar at 15 and 30 minutes (P > .5). Discharge times from the PACU were also similar for the 3 groups, at 75.12, 78.43, and 81.29 minutes, respectively (P > .5).
Risk factors for paediatric emergence agitation may include the general anaesthetic used; faster emergence from anaesthesia; presence and severity of postoperative pain; head, eye, ear, nose and throat surgeries; general temperament of patient; and age under 6 years, the authors noted.