Effect of dexmedetomidine on emergence agitation in children undergoing adenotonsillectomy under sevoflurane anesthesia

Background: Emergence agitation (EA) is one of the postoperative complications after adenotonsillectomy. Sevoflurane anesthesia is associated with a high incidence of emergence agitation in infants and children. Pharmacological intervention such as the use of dexmedetomidine (DEX) may be necessary to decrease EA. Aim: This study was conducted to assess the effect of adding 0.5 mcg/kg of dexmedetomidine on the emergence agitation scale on children undergoing adenotonsillectomy under sevoflurane anesthesia without any premedication. Methods: In a prospective double-blind clinical trial study of 60 children (aged 4-14 years old) who underwent elective adenotonsillectomy, patients parents consents were obtained before starting operations. Anesthesia was induced with 5-8% sevoflurane and 100% oxygen (6 L/min) via facemask. Venous cannulation was established, then dexamethasone at a dose of 0.15 mg/kg was given, propofol (1-2 mg/kg), fentanyl (0.5 mcg/kg), and rocuronium (0.6 mg/kg); after tracheal intubation, sevoflurane concentration was maintained at 2-4 vol. % in 100% oxygen (6 L/min) after intubation. At the end of the procedure, sevoflurane was discontinued, and residual muscle relaxation was reversed. Vital signs, agitation scale, tracheal extubation time, and emergence time were recorded. Results: The study group consisted of 60 patients. Age, weight, sex, and SPO2 show no significant differences in both groups. In an analysis of pulse rate data, mean blood pressure, cough attacks, and breath holding, a significant relationship was observed between the two groups. The incidence of hypoxic episode, hypotension attack, and bradycardia in both groups was zero. A significant relationship was found between the two groups in terms of the pediatric anesthesia emergence agitation scale (1-5). Times to emergence and time of tracheal extubation in group A was significantly shorter than that in placebo group B. Conclusion: IV bolus administration of (0.5) mcg/kg dexmedetomidine significantly decreased the incidence and severity of agitation development after adenotonsillectomy among children who received sevoflurane anesthesia. The anesthesia did not lead to an increased incidence of side effects and also provided smooth extubation.