Effects Of Dexmedetomidine Nasal Spray On Sedation Of Children In Different Age Groups In Tonsillectomy And Adenoidectomy

Objective:To explore the effects of different doses of Dexmedetomidine?DEX?on preoperative nasal spray on preoperative sedation,postoperative sedation,analgesia and perioperative circulation during the operation of tonsillectomy and adenoidectomy under general anesthesia in children of different age groups.The purpose of this study was to select the appropriate preoperative dosage of DEX for children of different ages.Methods:160 children underwent selective tonsillectomy and adenoidectomy in the affiliated Shengjing hospital of China Medical University.The children were divided into the younger group?1-3 years old,group L?and the older group?4-8 years old,group H?according to age,with 80 children in each group.The young group?group L?was randomly divided into four subgroups:experimental group L₁,L₂,L₃ and control group C_L,with 20 participants in each group.DEX0.5ug/kg,DEX1.0ug/kg,DEX1.5ug/kg,normal saline 0.5ml nasal spray were administered 30 minutes before surgery.Similarly,the elderly group?group H?was randomly divided into four subgroups:experimental group H₁,H₂,H₃ and control group C_H,with 20 participants in each group.DEX0.5ug/kg,DEX1.0ug/kg,DEX1.5ug/kg,normal saline 0.5ml nasal spray were administered30 minutes before surgery.In the waiting room before surgery,HR and SpO₂ of the children were recorded before and after administration?15min,30min?.Satisfactory sedation onset time?Ts?was achieved after administration,as well as the satisfaction of Separation from parents.When the children entered the operating room,the Ramsay sedation score of the children was evaluated,and the mask acceptability of the children was calculated.The score of restlessness,operation time,recovery time and adverse reactions of respiratory and circulatory system were recorded after the operation.After leaving the operating room and arriving at PACU,Ramsay sedation score and FLACC analgesia score were performed at 3 time points?PACU,15 minutes and 30 minutes after PACU?.Results:The preoperative sedation effect of H₂,H₃,L₂ and L₃ groups was significantly different from that of the control group?p<0.05?,The degree of satisfactory separation from parents,satisfaction of Ramsay score and mask acceptance were significantly increased?p<0.05?.Moreover,the onset time of sedation of H₃ group and L₃ group was shorter than that of H₂ group and L₂ group?p<0.05?.One child in the L₃ group developed deep sedation.The score of postoperative restlessness in H₂ and H₃ groups was significantly reduced compared with the control group?p<0.05?.H₂ and L₂ groups had significantly lower FLACC analgesia scores compared with the control group?p<0.05?,while Ramsay sedation scores and FLACC analgesia scores of H₃ and L₃ groups were significantly lower than those of the control group?p<0.05?.In the H₃,L₂ and L₃ groups,there were decreased heart rate and delayed extubation,among which the L₃ group had the most significant change?p<0.05?.Conclusion:The dose of DEX preoperative nasal spray was 1.5ug/kg in the elderly group,1.0ug/kg in the younger group,which can maximize the success rate of preoperative sedation,prevent postoperative agitation,and play the role of postoperative sedation and analgesia while ensuring the safety of children.