Dexmedetomidine versus ketofol effect on the incidence of emergence agitation associated with sevoflurane-based anesthesia in children undergoing orthopedic surgery

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Pediatric anesthesia emergence delirium (PAED) scale.

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

able 2 Objective Pain Scale (OPS).

Parameter	Finding	Points
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

able 3 Modified Aldrete scoring system.

Assessment items	Condition	Grade
Activity, able to move, voluntarily or on command	4 extremities	2
	2 extremities	1
	No	0
Breathing	Able to breathe deeply & cough freely	2
	Dyspnea, shallow or limited breathing	1
	Apnea	0
Consciousness	Fully awake	2
	Arousable on calling	1
	Unresponsive	0
Circulation (BP)	±20% of pre-anesthesia level	2
	±20% to 49% of pre-anesthesia level	1
	±50% of pre-anesthesia level	0
SPO2	Maintains SpO2 >92% in ambient air	2
	Maintain SpO2 >90% with O2	1
	Maintain SpO2 <90% with O2	0

able 4 Demographic and anesthetic data of the study groups.

Demographic data	Group K N = 30	Group D N = 30	Group C N = 30
Age (years): Mean ± SD	4.2 ± 1.5	4.3 ± 1.58	4.5 ± 1.76
Gender (Male/Female)	17/13	19/11	20/10
Weight (kg): Mean ± SD	16.7 ± 4.02	17.5 ± 3.5	16.9 ± 3.8
ASA (I/II)	19/11	21/9	22/8
Operative time (min): Mean ± SD	43.5 ± 11.8	43.2 ± 11.8	45.1 ± 12.4
Sevoflurane duration (min) Mean ± SD	58.5 ± 6.2	59.2 ± 6.8	61.18 ± 10.3

able 5 Incidence of emergence agitation at T0, T10, T20 and T30 in the study groups.

Agitation	Group K N = 30	Group D N = 30	Group C N = 30
T0	8 (26.7%)^#	5 (16.7%)^†	27 (90%)^#^,^†
T10	3 (10%)^#	3 (10%)^†	18 (60%)^#^,^†
T20	0 (0%)	0 (0%)	5 (16.7%)^#^,^†
T30	0 (0%)	0 (0%)	0 (0%)

^∗ P < 0.05 K vs. D groups.

P < 0.05 K vs. C groups.

#x2020; P < 0.05 D vs. C groups.

able 6 PAED score (Mean ± SD) at T0, T10, T20 and T30 of the study groups.

PAED score Mean ± SD	Group K N = 30	Group D N = 30	Group C N = 30
T0	10.1 ± 0.35 ^#	10 ± 0.25^†	15.2 ± 0.8 ^#^,^†
T10	9.3 ± 1.15 ^#	9.1 ± 0.57^†	12 ± 1.3 ^#^,^†
T20	7 ± 0^#	6.9 ± 0.57 ^†	9 ± 0 ^#^,^†
T30	4.9 ± 0.57	4.86 ± .53	5 ± 1

^∗ P < 0.05 K vs. D groups.

P < 0.05 K vs. C groups.

#x2020; P < 0.05 D vs. C groups.

able 7 Recovery characteristics of the study groups.

	Group K N = 30	Group D N = 30	Group C N = 30
Extubation time (min) Mean ± SD	9.08 ± 1.7^⁎^,^#	12.8 ± 1.95^⁎^,^†	4.7 ± 1.6^#^,^†
Time to modified Aldrete score ⩾9: (min) Mean ± SD	14.2 ± 2.1^⁎^,^#	17.1 ± 2.5^⁎^,^†	9.2 ± 2.4^#^,^†
Time of 1st analgesic requirement (min) Mean ± SD	91.58 ± 12.2^⁎^,^#	34.1 ± 6^⁎^,^†	9.2 ± 2.4^#^,^†

#x204E; P < 0.05 K vs. D groups.

P < 0.05 K vs. C groups.

#x2020; P < 0.05 D vs. C groups.

igure 1 Mean heart rate changes (beat/min) among the study groups.

igure 2 Changes in mean arterial blood pressure (mmHg) among the study groups.