Minerva Pediatrics 2021 Sep 13

DOI: 10.23736/S2724-5276.21.06330-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Dexmedetomidine reduced the severity of emergence delirium and respiratory complications, but increased intraoperative hypotension in children underwent tonsillectomy. A retrospective analysis

Alessandro SIMONINI ¹ ✉, Etrusca BROGI ², Giorgio CONTI ³, Alessandro VITTORI ⁴, Marco CASCELLA ⁵, Maria G. CALEVO ⁶

¹ Department of Pediatric, Anaesthesia and Intensive Care, Salesi Children’s Hospital, Ancona, Italy; ² Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy; ³ Department of Anesthesia and Intensive Care, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; ⁴ Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy; ⁵ Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Naples, Italy; ⁶ Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

BACKGROUND: Intraoperative dexmedetomidine can be useful for its sedative and analgesic sparing effects, and for the prevention of emergence delirium. Conversely, it can cause hypotension and bradycardia. The aim of this study was to assess the safety and efficacy of dexmedetomidine in pediatric anesthesia.
METHODS: This is a retrospective cohort study in children who received intravenous dexmedetomidine (Dex group) or opioids (No-Dex group) during general anesthesia for tonsillectomy, between November 2014 and November 2016. From the medical records, data on the intraoperative phase (hemodynamic adverse events, respiratory failure at the emergence, awakening and extubation times, emergence delirium), recovery room (pain, hemodynamic parameters, and desaturation), and ward stay (pain, and nausea and vomiting) were investigated. Time of hospital discharge was calculated.
RESULTS: Three hundred twenty-eight (Dex group 183; No-Dex group 145) children ranging from 1.5 to 10 years were included. The percentage of intraoperative hypotension was significantly higher in the Dex group (p=0.01). The extubation times were significantly higher in No-Dex group (p=0.0001), although the awakening times were significantly longer with dexmedetomidine (p= 0.0001). Desaturation episodes were higher in the Dex group (p=0.0001). The incidence of emergence delirium was similar in the two groups, but of greater intensity in the No-Dex group. While in the immediate postoperative period there was no difference in pain, after 24 hours, the incidence of pain and vomiting was significantly higher (p=0.003; p=0.0001) in the No-Dex group.
CONCLUSIONS: Although several outcome parameters showed important advantages of dexmedetomidine over opioid-based regimens in terms of safety and efficacy, issues such as the increased intraoperative hypotension, indicated that it is not possible to draw any definitive conclusions.

KEY WORDS: Dexmedetomidine; Emergence delirium; Pain; Tonsillectomy; Laryngospasm