Effect of Caudal Dexmedetomidine on Prevention of Postoperative Agitation after Sevoflurane Anesthesia in Children: A Prospective Randomized Study

Abstract
Background: Sevoflurane commonly used in pediatric anesthesia for inhalational induction and maintenance, however Emergence Agitation (EA) in children after sevoflurane anesthesia is common, with reported incidence up to 80%. Dexmedetomidine is a selective alpha 2 receptor agonist and has sympatholytic, analgesic and sedative properties with minimal respiratory effects.
Aim: The aim of this study is to evaluate the effect of caudal dexmedetomidine on prevention of agitation after sevoflurane anesthesia as a primary outcome measure. Also post-operative analgesia will be studied as secondary outcome measures.
Material and Methods: This study was carried out on 120 children, 1-6 years, ASA I, scheduled for elective lower abdominal surgery. Patients were randomized into 3 equal groups (40 patients in each group): Group I: Dexmedetomidine group (DEX): Received caudal anesthesia with dexmedeto-midine 1ug/kg and 1ml/kg bupivacaine 0.25%, Group II: Received caudal anesthesia with1ml/kg bupivacaine 0.25%. Group III: Received general anesthesia without caudal block. Hemodynamics: (HR & MAP) and SpO2 before induction and every 10 minutes for 1st 2 hours andat 15-min intervals for 1h. post-operatively, depth of anesthesia, incidence of emergence agitation after extubation and for 10min in the PACU by Aono's four-point scale. at 15-min intervals for 1h. Post-operative pain was assisted by CHIPPS.
Results: Hemodynamics (HR & MAP) only significant decrease in MAP and HR in DEX group. EA was significantly lower in DEX group, CHIPPS was significantly lower in Group I, BIS value was low in DEX group, fentanyl require-ment was lower in Group 1.
Conclusions: The use of dexmedetomidine (1μg/kg) added to bupivacaine in caudal block in sevoflurane-anaesthetized children significantly decreased the occurrence of EA and prolonged duration of post-operative analgesia.