Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

• Intranasal dexmedetomidine improves acceptance of sevoflurane induction via mask.
• Intranasal dexmedetomidine minimizes emergency agitation mainly from sevoflurane.
• Dexmedetomidine can be safely administrated without delaying the emergency time.

Study ObjectivesThis study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia.DesignSingle-blinded, randomized, placebo-controlled clinical comparison study.SettingAcademic medical center.PatientsNinety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery.InterventionsPatients were randomized into 3 groups: group D1, group D2, and saline group (group C), in which the children received 1 or 2 μg/kg of intranasal DEX or saline, respectively, and each group comprises 30 patients.MeasurementsThe mask induction score and the incidences of postoperative emergence agitation evaluated by the Pediatric Anesthesia Emergence Delirium scale were assessed. The emergence time, postanesthesia care unit (PACU) stay time, and any adverse events were recorded.Main ResultsThe mask induction scores were significantly higher in the saline group than those in the D1 and D2 groups (P < .001). The incidences of emergence agitation in the D1 and D2 groups were significantly lower than that in the saline group (7/30 in group D1 and 3/30 in group D2 vs 24/30 in group C, P < .001). The emergence time and PACU stay time were comparable among the 3 groups (P > .05). The emergence time and PACU stay time did not differ significantly in DEX-treated groups as compared with the saline group; there were no differences between 1- and 2-μg/kg groups. None of the patients exhibited significant clinical complications.ConclusionIntranasal DEX (1 or 2 μg/kg) dose independently improves the incidences of mask acceptance and prevents the incidences of postoperative emergency agitation mainly from sevoflurane without delaying the emergency time or inducing severe adverse events.