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Appropriate dose of dexmedetomidine for the prevention of emergence agitation after desflurane anesthesia for tonsillectomy or adenoidectomy in children: up and down sequential allocation

 Hee-Soo Kim  ;  Hyo-Jin Byon  ;  Jong-Eun Kim  ;  Yong-Hee Park  ;  Ji-Hyun Lee  ;  Jin-Tae Kim 
 BMC ANESTHESIOLOGY, Vol.15 : 79, 2015 
Journal Title
Issue Date
Adenoidectomy/methods* ; Anesthetics, Inhalation/administration & dosage ; Child ; Child, Preschool ; Dexmedetomidine/administration & dosage* ; Dose-Response Relationship, Drug ; Female ; Humans ; Hypnotics and Sedatives/administration & dosage ; Isoflurane/administration & dosage ; Isoflurane/analogs & derivatives ; Male ; Methyl Ethers/administration & dosage ; Psychomotor Agitation/prevention & control* ; Tonsillectomy/methods*
Children ; Desflurane ; Dexmedetomidine ; Emergence agitation
BACKGROUND: Dexmedetomidine can be used for the prevention of emergence agitation (EA) in children. However, an inadequate dose of dexmedetomidine can induce prolonged sedation and cardiovascular complications. The aim of this study was to evaluate the effective dose of dexmedetomidine for the prevention of EA after desflurane anesthesia for patients undergoing a tonsillectomy or adenoidectomy.

METHODS: We enrolled 21 unpremedicated children, between 2 and 12 years, undergoing either a tonsillectomy or an adenoidectomy. General anesthesia was induced using sevoflurane and oxygen, and dexmedetomidine was administered before surgery. Anesthesia was maintained using desflurane resulting in a BIS range of 40-60. In the postanesthetic care unit (PACU), EA (agitation measured at level 4 or more at least once) was assessed on arrival in the PACU,15 min later, and 30 min later. The dose of dexmedetomidine for consecutive patients was determined by the response of the previous patient, using an increment or decrement of 0.1 μg/kg.

RESULTS: The 50% effective dose of dexmedetomidine for prevention of EA was 0.25 μg/kg (95% confidence limits, 0.17-0.33 μg/kg), and the 95% effective dose was 0.38 μg/kg (95% confidence limits, 0.29-0.39 μg/kg).

CONCLUSIONS: For prevention of EA after desflurane anesthesia for 50% and 95% of children undergoing tonsillectomies or adenoidectomies, 0.25 μg/kg or 0.38 μg/kg of dexmedetomidine is suggested. Further study is needed to validate the suggested dose of dexmedetomidine to prevent the EA that was identified in the present study.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Byon, Hyo Jin(변효진)
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