A Study of Effect of Intranasal Dexmedetomidine on Minimum Alveolar Concentration of Sevoflurane for I-Gel Insertion and Emergence Delirium in Children

Abstract Introduction: Most pediatric patients have anxiety during the preoperative period, which may be due to separation from parents, fear of injections, operation theatre, or unfamiliar faces. This leads to stress, tachycardia, agitation or excessive crying, which make the management of such patients difficult during induction of anaesthesia. Emergence delirium (ED) is a post-surgical phenomenon associated with an increase in morbidity, mortality and resource utilization. Dexmedetomidine (Dex) deepens the level of anaesthesia and facilitates smooth inhalation induction. But there is dearth of literature in children about the use of Dex reducing anesthetic requirement. However, the dose related effects of Dex premedication on the minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion (MACLMA) remain undetermined in children. Material & Methods: It was a prospective observational study of 80children; aged 6 months -8 years, with ASA I and II; scheduled for elective infraumbilical surgeries of duration 45 minutes to one hour under general anesthesia with supraglottic devices. Results: Behavior of patient while entering operation theatre was significantly better in Dex group (1=0%, 2=55%, 3=45%) compared to control group. (1=97.5%, 2=2.5%, 3=0%) (P=0.001). Quality of mask acceptance was significantly better in Dex group (1=0%, 2=0%, 3=50%, 4=42.5%, 5=7.5%) compared to control group (1=87.5%, 2= 10%, 3=2.5%, 4=0%, 5=0%) (P=0.001). Dex group required shorter time for loss of eyelash reflex as compared to control group, centralization of pupil, jaw relaxation and i-gel insertion. Emergence agitation by WATCHA scale and pain assessment by FLACC scale was significantly less in Dex group as compared to control. Parental satisfaction was significantly better as compared to control group. Conclusion: Intranasal Dex 1 μg/kg reduces MAC requirement for i-gel insertion and postoperative emergence delirium. In addition, it also provides better sedation level, better behavior of child while entering operation theatre, better acceptance of mask while inducing the child, perioperative hemodynamic stability, analgesia and parental satisfaction.