The Effect Of Dexmedetomidine On Emergence Agitation In Infants With Cleft Lip And Palate Anesthesia

Background and Objectivewith the rapid development of plastic surgery,infants with cleft lip and palate surgery,if their own conditions allow,early surgery for correction of malformation is recommended as soon as possible,especially for children with cleft lip.The early restoration of the shape and function of the upper lip is beneficial to the development of the upper lip.At present,most of the cleft lip repair operations in our hospital are completed at the early age.However,cleft lip and palate surgery,especially cleft palate surgery,with severe postoperative pain,gauze packing and hemorrhage,etc.has strong stimulation to the throat,and children are prone to agitation during general anesthesia recovery,leading to bleeding,coughing,aspiration,and even opening of the wound.In addition,the children are younger and have changed their oral structure.Severe agitation during recovery increases the risk of respiratory tract obstruction and asphyxia,and can endanger the life of the child.Therefore,how to preventthe agitationduring sevoflurane anesthesia with the operation of cleft lip and palate is a problem,so that the child can smoothly survive the general anesthesia recovery period.It is very important to ensure perioperative safety and quality of operation in children.At present,for the agitation of general anesthesia with infants,many anesthesiologists do not deal with it for safety reasons,allowing them to relieve themselves,and children who are struggling with severe crying may be taken physical restraints.,or be sent to the anesthesia recovery room prematurely,without enough time for observation,increasing the safety risk of the child.The sedative effect of dexmedetomidine is similar to natural sleep,and has little effect on the respiratory system.Hemodynamics are stable during the perioperative period.Currently,the research on dexmedetomidine in preventing agitation during general anesthesia in children is mostly concentrated on older child,such as tonsil adenoidectomy,and for infants with cleft lip and palate surgery,relatively few studies at home and abroad are reported,and the dose,timing and clinical effects of dexmedetomidine are also not same.our Objective is to observe the effect of dexmedetomidin on the prevention of agitation during sevoflurane anesthesia in infants w ith cleft lip and palate surgery.MethodsSixty children who was undergoing cleft lip and palate repair,aged 5 to18months,weighed more than 6 kg were randomly divided into two groups（n=20 each）,0.5μg/kg dexmetomidine（group D）and normal saline（group C）.Anesthesia was induced by propofol 2-3 mg/kg,fentanyl 3μg/kg,cisatracurium 0.1 mg/kg.After consciousness disappeared,dexmedetomidine or saline is pumped.The time is 10minutes.Intraoperative anesthesia was maintained with remifentanil 0.1-0.2μg/kg/min·and sevoflurane 1%–3%and propofol 2 mg?·?kg-1?·?h-1.During the operation,the dosage was appropriately adjusted according to the surgical stimulation intensity and hemodynamic parameters,so that the blood pressure and heart rate were maintained within 20%of the preoperative value.Ventilator parameters:tidal volume 7¹0ml/kg,respiratory rate 20³0 times/min,inspiratory/influence ratio 1:1.5,proper adjustment of respiratory parameters during surgery to ensure end-tidal carbon dioxide（PETCO₂）maintained at 35⁴0.intraoperative ECG,blood pressure,pulse oximetry,and end-tidal carbon are routinely monited.Record general information such as age,sex,weight,type of surgery.HR and SBP were recorded at 5 time points:the baseline value（T0）、before administration of Dex（T1）、beginning of surgery（T2）,20min after operation（T3）and removing the endotracheal tube is pulled out（T4）.Recording of operative time,recovery time（the end of surgery to the patient has a purposeful limb movement,biting the trachea tube or calling to open the eyes was recorded as wake-up time）,extubation time,and retention time in the anesthesia recovery room.the patient’s agitation was recorded（five-grade agitation score and PAED score）,and adverse events（such as drowsiness,throat,hypoxemia,aspiration）.Results1.There was no significantly difference between the two groups in terms of age,gender,weight,type of operation,and operation time（P>0.05）.2.Compared with T0,the HR and SBP at T1^T3 were significantly decreased in group C（P<0.05）;compared with T0,The HR and SBP at T1^T4 were significantly decreased in group D（P<0.05）.Compared with group C,the HR at T2-T4 in group D were significantly decreased（P<0.05）.The SBP at T4 was significantly decreased in group D when compared with group C（P<0.05）.3.The incidence of agitation in C and D groups was 70.0%,26.7%,respectively and The PAED degree of agitation was 13.4±3.2、8.5±2.6,respectively,and there were significant difference（P<0.05）.The FLCAA score in group D was significantly lower than that in group C（6.4±0.9、3.5±0.6）,and the difference was statistically significant（P<0.05）.4.The incidence of severe cough score during tracheal extubation was 36.7%and10%,respectively,ndthereweresignificant difference（P<0.05）.There was no significant difference in the incidence of narcolepsy,oxygen saturation,aspiration and laryngospasm（P>0.05）.5.There was no significantly difference between the two groups in terms of recovery time,extubation time and Discharge to recovery room（P>0.05）.ConclusionsA single intravenous dose of 0.5μg/kg dexmedetomidine after induction in infants with cleft lip and palate surgery,can significantly decrease the incidence and severity of agitation and pain scores during anesthesia recovery the hemodynamics during perioperative period is greater smoothly.