The Impact of Preoperative Low-Dose Esketamine and Dexmedetomidine Nasal Administration on the Emergence Delirium in Children Undergoing Fiber Bronchoscopy: A Prospective Randomized Controlled Trial

OBJECTIVE: This study aimed to investigate the effects of preoperative low-dose esketamine and dexmedetomidine nasal administration on the incidence of postoperative emergence delirium in children undergoing fiber bronchoscopy. METHODS: A total of 129 patients, of any gender, aged 1 to 6 years, with ASA grades I and II, who were scheduled for fiber bronchoscopy, were randomly divided into three groups (n = 43) using a random number table method: 1.0 mg/kg of esketamine, 1.0 μg/kg of dexmedetomidine, and an equal volume of normal saline (group control). The respective dose of the drug or normal saline was rapidly instilled through both nostrils using a 1-mL syringe. The primary outcome measure was the incidence of emergence delirium. The secondary outcome measures included postoperative pain intensity, time to awaken and open eyes in the postanesthesia care unit, incidence of postoperative adverse behavior, hemodynamics, and duration of stay in the postanesthesia care unit. RESULTS: A total of 126 patients completed the study, and compared with the group control (48.78%), the 1.0 mg/kg esketamine (7.14%) and 1.0 μg/kg dexmedetomidine (18.6%) had a lower incidence of postoperative emergence delirium ( P < 0.01), as well as lower postoperative pain intensity ( P < 0.01). However, compared with the group control, the 1.0 μg/kg dexmedetomidine had a prolonged time to awaken and open eyes in the postanesthesia care unit ( P < 0.05). The duration of hemodynamics, oral secretion volume, and stay in the postanesthesia care unit were similar among the three groups. CONCLUSIONS: The findings suggest that low-dose esketamine and dexmedetomidine can reduce the incidence of emergence delirium.