الفهرس 
Pain in pediatricsOnly 14 pages are availabe for public view
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Abstract
BACKGROUND: Dexmedetomidine, a specific α2 agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease pain, emergence agitation in children undergoing adenotonsillectomy.
METHODS: This prospective, randomized study was conducted on seventy pediatric patients, aged three to seven years, of both sex, ASA I and II, scheduled for elective adenotonsillectomy, presenting to Ain Shams University hospitals. Approval had been obtained from the research ethics committee of anesthesia and intensive care and pain department, Ain Shams University. After mask induction with sevoflurane, group 1 received IV dexmedetomidine (2 μg/kg) over 10 minutes, followed by (0.7 μg/kg/ hour) until 5 minutes before the end of the surgery, group 2 received IV fentanyl bolus (1 μg/kg) as a bolus. Anesthesia was maintained with sevoflurane, oxygen. Fentanyl (0.5-1 μg/kg) was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above pre incision values that continued for 5minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale (PAED) and a 5-point scale described by Cole. Pethidine (0.5-2mg/kg) is given as IM or slow IV for Postoperative pain (score > 4) or severe agitation (score 4 or 5) lasting more than 5 minutes.
RESULTS: In group 1, 11.4% patients needed intraoperative rescue fentanyl in comparison with 37.1% in group 2 (P = 0.012). Mean systolic blood pressure and heart rate were significantly lower in group 1 (P < 0.01). The median objective pain score was 3 for group 1 and 5 for group 2 (P < 0.001). In group 1, 6 (17.1%) patients required rescue pethidine, in comparison with 16 (45.7%) in group 2 (P = 0.010). Emergence agitation was significantly lower in group1on arrival to the PACU, 30, and 60 minutes postoperative by the use of 5-point scale described by Cole (P < 0.01); and by the use of (PAED) score on arrival to PACU, 5, 30, 60, 75, 90, 105 minutes postoperatively (P < 0.001). The duration of agitation on the Cole scale was statistically shorter in group 1 (P < 0.05). In group 1, 17.1% of patients and 40% in group 2 had an episode of SPO2 below 95% (P = 0.034).
CONCLUSIONS: An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for adenotonsillectomy without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.