Effects of preoperative intranasal dexmedetomidine on postoperative emergency agitation in children

Objective To investigate the effects of preoperative intranasal dexmedetomidine on postoperative emergency agitation after pediatric inhalation combined with anesthesia. Methods A total of 10 patients, aged 2—6 years old, ASA grade Ⅰ, who underwent single-site inguinal hernia repair in the Affiliated Hospital of Xuzhou Medical University from April to December 2018 were enrolled. According to the random number table method, they were divided into two groups (n=50): a dexmedetomidine (D) group and a Control (C) group. Then, the D group was administered with 1 μg/kg dexmedetomidine (diluted to 0.4 ml) before surgery, while the same volume of normal saline was given to the C group. After 35 min, all children were accompanied by their parents for anesthesia induction. Their sedation score and mask induction quality score were recorded. Their mean arterial pressure and heart rate were recorded when patients entered into the room, after tracheal intubation, when the skin was cut, when the laryngeal mask was removed. The pediatric anesthesia emergence delirium (PAED) scores and FLACC behavioral pain assessment scale scores were recorded immediately after emergence (T₁), and 5, 10, 15 and 30 min during the recovery period (T₂, T₃, T₄ and T₅). The operation time, recovery time, and the length of PACU stay, and the incidences of adverse events (such as throat spams, bradycardia, nausea and vomiting) were recorded. Results Compared with the C group, the D group presented increases in the preoperative sedation satisfaction rate and mask inhalation induction cooperation satisfaction rate, decreases in the mean arterial pressure and heart rate, decreases in the incidence of postoperative agitation, and decreases in PAED scores and FLACC scores during the recovery period (P＜0.05). There was no significant difference in operation time, recovery time, the length of PACU stay and the incidence of adverse reactions between the two groups (P＞0.05). Conclusions Preoperative intranasal dexmedetomidine can reduce the incidence of emergency agitation during the recovery period and reduce preoperative anxiety, with slight impact on pediatric hemodynamics.