Effect of Dexmedetomidine in Preventing Postoperative Emergence Agitation in Children Undergoing Adenotonsillectomy: A Retrospective Observational Study

Abstract Context: Emergence agitation (EA) is a frequently encountered postoperative complication in children after adenotonsillectomies. Aim: Our study aimed to see the effect of dexmedetomidine on the presence and severity of EA in children, 2–8 years old, undergoing adenotonsillectomies under sevoflurane anesthesia, and to compare the effectiveness of two doses (0.5µg/kg and 0.75µg/kg) in reducing EA. Subjects and Methods: Medical records of a total of 197 children (American Society of Anesthesiologists I/II, aged 2–8 years) were analyzed. Group I ( n = 89) did not receive dexmedetomidine, Group II ( n = 108) received either 0.5 µg/kg (Group A) or 0.75 µg/kg (Group B) as intravenous infusion over 10 min at induction. The presence of EA was assessed using the Four-Point Agitation Scale (AONO)scale (EA≥3) and severity using the Pediatric Anesthesia Emergence Delirium Scale, (EA severity ≥10), at extubation and 10, 20, and 30 min postoperatively. Hemodynamics and adverse events were documented. Statistical Analysis: Mean ± standard deviation and an Independent t test were used to compare continuous variables. For categorical variables, the Chi square test was used. Results: Heart rate and systolic blood pressure were lower in the dexmedetomidine group (Group II), but without any adverse effects. Both the presence and severity of EA were significantly lower in the dexmedetomidine group (II). No statistically significant difference was found between the two dexmedetomidine doses, 0.5 µg/kg or 0.75 µg/kg, in reducing Emergence Agitation ( P > 0.05). Conclusions: The presence and severity of EA in children undergoing adenotonsillectomies are effectively reduced using intravenous dexmedetomidine. When administered as a slow infusion after intubation, a dose of 0.5 µg/kg is as effective as 0.75 µg/kg in preventing emergence, and both doses maintain stable hemodynamics. The result of this study shows reduced Emergence Agitation, safer and smooth recoveries with dexmedetomidine and support it’s use as adjunct for pediatric adenotonsillectomies.