Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.07.001
Brazilian Journal of Anesthesiology
Scientific Article

Oral trans‐mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial

Dexmedetomidina transmucosa oral para controle da agitação ao despertar em crianças submetidas a amigdalectomia: ensaio clínico randomizado

Hala S. Abdel-Ghaffar, Amani H. Abdel-Wahab, Mohammed M. Roushdy

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Abstract

Objectives
Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia.

Methods
Ninety patients aged (3‐6y), ASA I‐II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 μg.kg‐1 (Group DEX I), 1 μg.kg‐1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects.

Results
The patients’ demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 minutes (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points.

Conclusion
This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo.

Keywords

Children; Tonsillectomy; Emergence agitation; Oral transmucosal buccal dexmedetomidine

Resumo

Objetivos
A agitação ao despertar da anestesia é um comportamento negativo comumente registrado após amigdalectomia pediátrica. Avaliamos a eficácia da pré‐medicação com dexmedetomidina via transmucosa oral no pré‐operatório sobre a incidência e gravidade da agitação ao despertar em crianças pré‐escolares submetidas à amigdalectomia sob anestesia com sevoflurano.

Métodos
Noventa pacientes entre três e seis anos e estado físico ASA I‐II foram incluídos em três grupos (n = 30) para receber 0,5 μg.kg‐1 ou 1 μg.kg‐1 de dexmedetomidina via transmucosa oral (Grupo DEX I e Grupo DEX II, respectivamente) ou solução salina (Grupo C). O desfecho primário foi o escore de agitação ao despertar medido com a escala de Watcha na SRPA. Os desfechos secundários foram escore de sedação pré‐operatória, hemodinâmica intraoperatória, escore OPS (Objective Pain Scale) e efeitos adversos no pós‐operatório.

Resultados
A demografia dos pacientes, os escores de sedação pré‐operatória e o tempo de extubação não apresentaram diferença entre os grupos. Diferenças significativas entre os grupos na distribuição da incidência e frequência de cada grau do escore de Watcha foram evidentes aos 5 minutos (p = 0,007), 10 minutos (p = 0,034), 30 minutos (p = 0,022), 45 minutos (p = 0,034) e 60 minutos (p = 0,026) no pós‐operatório, com diferenças significativas entre os grupos DEX I e II. Os grupos DEX apresentaram escores OPS mais baixos aos 5 minutos (p = 0,011), 10 minutos (p = 0,037) e 30 minutos (p = 0,044) após a chegada à SRPA, sem diferença entre os grupos DEX I e II. Os pacientes do grupo DEX II apresentaram menor frequência cardíaca média aos 15 minutos de intraoperatório (p = 0,020) e menor pressão arterial média aos 30 minutos, (p = 0,040), 45 minutos (p = 0,002) e 60 minutos (p = 0,006), sem diferenças significativas entre os grupos em outros momentos.

Conclusão
Este estudo demonstra a vantagem clínica e a técnica simples da pré‐medicação com DEX por via transmucosa oral para agitação ao despertar em crianças pré‐escolares submetidas à amigdalectomia sob anestesia com sevoflurano, comparado à solução salina.

Palavras-chave

Crianças; Amigdalectomia; Agitação ao despertar; Dexmedetomidina transmucosa oral

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