Single-Dose Dexmedetomidine Reduces Agitation After Sevoflurane Anesthesia in Children

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Abstract
Emergence agitation is a common side effect of sevoflurane anesthesia in children. Dexmedetomidine, because of its sedative and analgesic properties, might be useful for the management of this adverse effect. We studied the effect of dexmedetomidine on recovery characteristics in 90 children aged 1 to 10 yr scheduled to undergo superficial lower abdominal and genital surgery. After inhaled induction with sevoflurane, patients were randomly assigned to receive saline (Group 1, n = 30), dexmedetomidine 0.15 micro g/kg (Group 2, n = 30), or dexmedetomidine 0.30 micro g/kg (Group 3, n = 30). After a laryngeal mask airway insertion a caudal block was performed in all patients. Maintenance of anesthesia was with 1% end-tidal sevoflurane and 50% nitrous oxide and spontaneous ventilation. Intraoperative hemodynamic and respiratory variables were recorded every 5 min. At the end of anesthesia time to eyes opening (TEO) and characteristics of emergence were recorded. General and intraoperative variables were similar in the 3 groups. The TEO was 7.5 +/- 5.0 min in Group 1, 8.2 +/- 5.0 min in Group 2, and 9.8 +/- 4.0 min in Group 3 (NS). The incidence (95% confidence interval) of agitation was 37% (20%-54%) in Group 1, 17% (4%-30%) in Group 2, and 10% (0%-21%) in Group 3 (P < 0.05). Paired comparisons showed a significant difference for Group 1 versus Group 3 (P < 0.05, 95% confidence interval of the difference: 7%-47%). The time to discharge from the postanesthesia care unit was similar for the 3 groups. We conclude that a dose of dexmedetomidine 0.3 micro g/kg administered after induction of anesthesia reduces the postsevoflurane agitation in children and with no adverse effects. In children undergoing surgery using sevoflurane anesthesia, dexmedetomidine 0.3 micro g/kg administered in 10 min after induction reduced the incidence of emergence agitation from 37% in the control group to 10%. No adverse effects attributable to dexmedetomidine were observed.