Effect of single-dose dexmedetomidine on the incidence of emergence delirium after sevoflurane-based anesthesia in children undergoing strabismus surgery

Backgroun: Though Emergence Delirium (ED) in children is a short duration, often self-limited, episodes, its prevention is essential. This study aims to evaluate the effect of single-dose dexmedetomidine on the incidence of ED in pediatrics who underwent strabismus surgery under sevoflurane-based anesthesia.Methods: The study consisted of 70 ASA I–II children who were 3–7 years old and scheduled for strabismus correction surgeries under sevoflurane anesthesia. The clinical trial registry is PACTR201911530033705, registered on the 3rd of November, 2019. Patients were randomly allocated into two groups (dexmedetomidine and control groups). Patients were administered either dexmedetomidine (0.3 µg/kg intravenous in 10 ml normal saline) or 10 ml normal saline, ten minutes before the end of the procedure (before discontinuation of sevoflurane). Our primary aim was to measure the incidence of ED. Watcha and PAED scores were measured simultaneously with FLACC score on arrival to PACU every ten minutes until 30 minutes, then at discharge. Besides, recovery time from anesthesia, length of PACU stay, parent’s satisfaction, and adverse effects were also recorded.Results: The incidence of ED was 17.6% and 57.6% in groups D and C, respectively. The Watcha and PAED scores were significantly higher in group C during PACU stay while FLACC score was significantly higher in group C on PACU arrival. Despite the significant delay of anesthetic recovery (p < 0.001), PACU stay was significantly shortened (p < 0.001) in group D. Parent’s satisfaction score was significantly better in group D (p = 0.002) without significant differences between both groups regarding adverse effects.Conclusions: This study demonstrates that a single dose of dexmedetomidine is effective in prophylaxis against ED in children after sevoflurane-based anesthesia. Despite its association with delayed recovery, dexmedetomidine shortened PACU stay and could be used safely in children.