Observation Of The Effect Of Intraoperative Dexmedetomidine On Postoperative Analgesia And Sedation In Pediatric Patients Undergoing Tonsillectomy And Adenoidectomy

BACKGROUND:The immediate postoperative period after tonsillectomy andadenoidectomy, one of the most common pediatric surgical procedures, isoften difficult. These children frequently have severe pain butpostoperative airway edema along with increased sensitivity to therespiratory-depressant effects of opioids may result in obstructivesymptoms and hypoxemia. Opioid consumption may be reduced bynonsteroidal anti-inflammatory drugs, but these drugs may be associatedwith increased bleeding after this operation. Dexmedetomidine has mildanalgesic properties, causes sedation without respiratory depression, anddoes not have an effect on coagulation. OBJECTIVE:To investigate the effect of intraoperative dexmedetomidine onpostoperative analgesia and sedation in pediatric patients undergoingtonsillectomy and adenoidectomy. Moreover, to search the ideal clinicaluse of dexmedetomidine in pediatric patients.METHODS:We designed a prospective, double-blind, randomized controlledstudy to determine the effects of intraoperative dexmedetomidine onpostoperative recovery including pain, sedation, and hemodynamics inpediatric patients undergoing tonsillectomy and adenoidectomy. Sixtypatients were randomized into four groups. Each group receive a singleintraoperative dose of dexmedetomidine0.5μg/kg with induced fentanyl2μ g/kg, induced fentanyl2μ g/kg and lactated Ringer solution,dexmedetomidine0.5μg/kg with induced fentanyl4μg/kg, inducedfentanyl4μg/kg and lactated Ringer solution over10minutes afterendotracheal intubation. The hemodynamics and sedation scores wererecorded in PACU, along with the time of the first rescue dose and timeto discharge. RESULTS:There were no significant differences among the4groups in patientdemographics, ASA physical status.(1)Patients receiving DxM had significantly slower heart rate in thefirst30minutes after surgery compared with those receiving lactatedRinger solution(P<0.05).（2）Patients receiving fentaynl2μg/kg with dexmedetomidine andfentanyl4μg/kg had a relatively longer time of extubation, compared tothose receiving fentanyl2μg/kg，yet much shorter than those receivingfentaynl4μg/kg with dexmedetomidine(P<0.05).(3)None of the patients showed difference in PACU durationexcept for those receiving fentaynl4μ g/kg with dexmedetomidine(P<0.05).Conclusion:Our prespective double-blinded randomized study shows thatintraoperative dexmedetomidine can steady hemodynamic and reduce theemergency agitation in PACU and the consumption of fentanyl inpediatric patients undergoing tonsillectomy and adenoidectomy without increasing extubation time and discharge time.