Effect of dexmedetomidine on emergence agitation in children undergoing adenotonsillectomy under sevoflurane anesthesia: A randomized controlled study

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Pediatric anesthesia emergence delirium scale [13].

Clinical Status	Not at all	Just a little	Quite a bit	Very much	Extremely
1. The child makes eye contact with the caregiver	4	3	2	1	0
2. The child’s actions are purposeful	4	3	2	1	0
3. The child is aware of his/her surroundings	4	3	2	1	0
4. The child is restless	0	1	2	3	4
5. The child is inconsolable	0	1	2	3	4

able 2 Objective pain scale for postoperative pain [14].

Parameter	Finding	Point
Systolic blood pressure	Increase <20% of preoperative blood pressure	0
	Increase 20–30% of preoperative blood pressure	1
	Increase > 30% of preoperative blood pressure	2
Crying	Not crying	0
	Responds to age-appropriate nurturing (tender loving care)	1
	Does not respond to nurturing	2
Movements	No movements relaxed	0
	Restless (moving about in bed constantly)	1
	Thrashing (moving wildly)	2
	Rigid (stiff)	2
Agitation	Asleep or calm	0
	Can be comforted to lessen the agitation (mild)	1
	Cannot be comforted (hysterical)	2
Complains of pain	Asleep	0
	States no pain	0
	Cannot localize	1
	Localizes pain	2

igure 1 CONSORT flow diagram of children undergoing adenotonsillectomy and participating in the study.

able 3 Demographic data of patients (Mean ± SD, number).

Item	Group A (n = 75)	Group B (n = 75)	P-value
Age (year)	8.38 ± 3.00	8.56 ± 3.08	0.713
Weight (kg)	21.12 ± 5.53	21.48 ± 3.99	0.861
Sex (male/female)	36/39	40/35	0.152

able 4 Intraoperative and postoperative data of patients (Mean ± SD, %, Number, Range, Median).

Item		Group A (n = 75)	Group B (n = 75)	P value
Heart rate (bpm)	T0	100.44 ± 6.83	99.63 ± 8.32	0.515^a
	T1	99.65 ± 8.43	97.23 ± 7.51	0.065^a
	T2	96.23 ± 5.25	94.62 ± 8.46	0.171^a
	T3	93.40 ± 8.58	92.74 ± 6.15	0.627^a
	T4	96.34 ± 8.14	95.87 ± 7.54	0.714^a
	T5	102.27 ± 6.71	99.80 ± 9.29	0.064^a
MAP (mmHg)	T0	82.52 ± 5.87	80.45 ± 8.30	0.079^a
	T1	77.50 ± 6.87	76.20 ± 5.28	0.196^a
	T2	76.94 ± 8.65	74.52 ± 7.39	0.068^a
	T3	78.36 ± 6.55	76.15 ± 7.42	0.055^a
	T4	79.66 ± 7.54	77.86 ± 8.48	0.172^a
	T5	81.35 ± 7.24	79.19 ± 9.38	0.117^a
ETCO2 (mmHg)		36.44 ± 1.76	36.50 ± 2.50	0.583^a
SPO2 (%)		99.06 ± 0.79	98.98 ± 0.91	0.363^a
Number of postoperative hypoxic episodes		–	–
Temperature (˚C)		37.06 ± 0.20	37.05 ± 0.16	0.872^a
Duration of anesthesia (minutes)		46.96 ± 6.85	46.82 ± 6.38	0.994^a
Duration of surgery (minutes)		39.74 ± 3.90	38.67 ± 3.44	0.733^a
End-tidal sevoflurane (%)		2.23 ± 0.31	0.82 ± 0.26	0.001
Total fentanyl dose (μg) [during procedure]		45.76 ± 9.82	36.80 ± 4.05	0.001^b
Fentanyl dose (μg/kg)		2.266 ± 1.76	1.42 ± 1.01	0.001^b
Extubation time (minutes)		17.06 ± 3.13	11.96 ± 2.26	0.001^b
PACU length of stay (minutes)		43.90 ± 6.72	34.8 ± 4.84	0.001^b
Total fentanyl dose (μg) in PACU		23.46 ± 4.52	15.88 ± 5.72	0.015^b
Modified Aldrete score	Mean	9.12 ± 0.718	9.32 ± 0.620	0.291^b
	Range	10–8	10–8
	Median	9	9

MAP: Mean arterial blood pressure, ETCO₂: End-tidal carbon dioxide, SPO₂: Arterial oxygen saturation, PACU: Post-anesthesia care unit.

T0: Reading before anesthesia induction, T1: Reading after anesthesia induction, T2: Reading 15 min after induction, T3: Reading at the end of anesthesia, T4: Reading at admission to PACU, T5: Reading before discharge to ward.

P > 0.05: The comparison is insignificant between the two groups.

P < 0.05: The comparison is significant between the two groups.

able 5 Complications related to the study (Mean ± SD, number, Range, Median, Percentage %).

Item		Group A (n = 75)	Group B (n = 75)	P-value
Bradycardia (Number of patients)		5	7	0.172^a
Hypotension (Number of patients)		4	5	0.211^a
Nausea and vomiting (Number of patients)		1	5	0.031^b
Objective pain score	Mean	7.25 ± 1.19	3.61 ± 0.82	0.001^b
	Range	10–3	6–2
	Median	6	3
Agitation (Number and percentage of patients)		29 (38.66%)	6 (8%)	0.001^b
Onset of emergence agitation		9.53 ± 3.82	5.13 ± 275	0.001^b

P > 0.05: The comparison is insignificant between the two groups.

P < 0.05: The comparison is significant between the two groups.

igure 2 Incidence of emergence agitation.

igure 3 Onset of emergence agitation.

igure 4 Objective pain score of patients. OPS: Objective pain score.