The effect of post-anesthetic administration of dexmedetomidine versus remifentanil on postoperative agitation of strabismus surgery in children: a randomized double-blind clinical trial

ABSTRACT

Introduction: Postoperative agitation is a common complication of sevoflurane anesthesia in children and might lead to self-harm and recovery disruption. This study aimed to compare the prophylactic effect of dexmedetomidine and remifentanil on postoperative agitation after anesthesia with sevoflurane. Methods: In this clinical trial, 60 children aged 2 to 7 years with ASA class І, II, candidates for elective strabismus surgery, were randomly assigned to three groups using block randomization. Patients in the first group D received 0.5 µgr/kg dexmedetomidine, the second group R received 0.1 µgr/kg remifentanil, and another group C received normal saline at the end of anesthesia. Children’s agitation degree was measured by the Pediatric Anesthesia Emergence Delirium (PAED) scales and the 4-point agitation scale at the time of extubation, entering the recovery room, 10, 20, and 30 minutes after entrance. Data analysis was performed using descriptive and inferential statistical tests. Results: The postoperative agitation and pain were significantly lower among children who received dexmedetomidine compared with those in remifentanil and the control group (p < .001). It was observed that the administration of dexmedetomidine at the end of anesthesia significantly decreased the incidence of postoperative agitation (p < .001). None of the patients in group D had a PAED score of over 12. Conclusion: Based on PAED and the 4-point scales, none of the cases in group D had experienced postoperative agitation; this made a significant statistical difference compared with groups C and R (p-value <. 001). Although both dexmedetomidine and remifentanil can prevent and attenuate postoperative agitation, dexmedetomidine administration seems significantly more effective.

KEYWORDS:

• Dexmedetomidine
• remifentanil
• strabismus

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data will be available on request. If someone requests the data of this study they can contact Dr Fatemeh Kanaani Nejad ([email protected]).

Authors’ contribution

All authors participated in the design of the study. M.S. was responsible for study conception, proposal writing, and article drafting and revising. M.J. was responsible for proposal preparation, data collection, and article drafting. A.P. and M.S. were responsible for study conception, Counseling, and article revision. M.B. was responsible for data analysis, manuscript preparation, and article writing and editing. F.K. was responsible for the final draft writing, article writing, and final revision. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The study protocol followed the Declaration of Helsinki and Good Clinical Practice guidelines and was approved by the Ethics Committee of Shiraz University of Medical Sciences. Written informed consent was taken from all the patients. This study was registered in the Iranian Registry of Clinical Trials (IRCT20121204011662N14), where the trial protocol can be accessed.

Additional information

Funding

The present article was extracted from a thesis written by Mina Jamshidi and was financially supported by grant number: [18846] from vice-chancellery research and technology in Shiraz University of Medical Sciences, Shiraz, Iran.