OBJECTIVES : To study the role of dexmedetomidine on emergence agitation and its effect on extubation in paediatric adenotonsillectomy. Our study involves the assessment of postoperative pain by Objective Pain Scale and need for rescue analgesia and other untoward events in PACU. The study also included the comparision of post operative recovery time by Modified Aldrete Recovery Score using dexmedetomidine and normal saline in adenotonsillectomy for pediatric patients.
METHODS : After induction of general anesthesia patient was put on controlled ventilation and maintained on sevoflurane 1.5-2% with 66% O2 and 33% N2O. At the end of surgery patients received either dexmedetomidine or normal saline over a period of 5 minutes, sevoflurane and nitrous oxide were discontinued, and residual muscle relaxation was reversed. Tracheal extubation time (time from anesthetic gas discontinue to tracheal extubation) and emergence time (time from anesthetic gas discontinue to eye opening on command) were recorded. Incidence of untoward airway events after extubation were also noted. The subject’s postoperative behaviour was assessed using Pediatric Anesthesia Emergence Delirium (PAED). In PACU, the intensity of pain was assessed by using an observational pain score (OPS). Any untoward events were noted and patient was shifted as per modified PACU score.
RESULTS: In this randomized comparative study, single dose of dexmedetomidine (0.5mcg/kg) was found to be associated with a statistically significant decrease in the incidence of emergence agitation along with smooth extubation in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. In addition, lower incidence of post-operative nausea and vomiting, lower pain score and shorter duration of stay in post-anesthesia care unit were observed. Although it was seen that the extubation was prolonged in the dexmedetomidine group in comparison to the placebo.
CONCLUSION: Dexmedetomidine reduces emergence agitation and provides smooth extubation in pediatric adenotonsillectomy patients on sevoflurane anesthesia.
DEXMEDETOMIDINE REDUCES AGITATION AND PROVIDES SMOOTH EXTUBATION AFTER PAEDIATRIC ADENOTONSILLECTOMY