The effects of intranasal dexmedetomidine on emergence agitation in children after propofol anaesthesia

Abstract Background: Both dexmedetomidine and propofol based anaesthesia are effective in reducing the incidence of emergence agitation in children. We investigated the efficacy of intranasal dexmedetomidine premedication in reducing emergence agitation in children undergoing circumcision.Methods: This was a double-blind, randomized, controlled trial. The primary outcome was the incidence of emergence agitation with and without intranasal dexmedetomidine premedication. Healthy children aged 5–12 years, scheduled for circumcision were randomly assigned to receive dexmedetomidine or placebo as premedication. Post-anaesthesia emergence agitation was assessed using the Post-Anesthesia Emergence Delirium (PAED) Scale.Results: Eighty-two children received intranasal dexmedetomidine and 83 children received intranasal saline. No patients in the dexmedetomidine group and one from the control group exhibited post-anaesthesia delirium with PAED > 10 (0 % vs. 1.2%, p > 0.99). Thirty-one out of 82 children (37.8%) receiving dexmedetomidine were satisfactorily sedated before induction, and 4 out of 83 (4.8%) after placebo (p < 0.001). Use of dexmedetomidine was associated with significantly reduced propofol use (24.0 mg.kg-1.hr-1 vs. 28.1 mg.kg-1.hr-1, p < 0.001) and a longer wake up time (58 vs. 46 minutes, p < 0.001). There was no difference in the use of analgesia in the recovery period nor in the incidence of post-operative nausea and vomiting.Discussion: Dexmedetomidine premedication has a pre-anaesthesia sedative effect and reduces propofol requirements intraoperatively but does not reduce emergence agitation in children who had propofol based anaesthesia for circumcision. Trial registration: Clinical Trial Registry of China(http://www.chictr.org.cn,ChiCTR2000032897).Retrospectively registered on 15/05/ 2020.