Pre‐operative dexmedetomidine nasal spray and emergence agitation in adults undergoing ear, nose and throat surgery: a randomised controlled trial

Emergence agitation is common after ear, nose and throat surgery, causing patient discomfort and increased risk of complications. We hypothesised that pre-operative dexmedetomidine nasal spray would reduce the incidence of emergence agitation in adult patients undergoing these procedures. We conducted a randomised double-blind controlled trial in adults scheduled for ear, nose and throat surgery. Patients were allocated (1:1) to receive nasal spray with dexmedetomidine (75-100 μg based on age and weight) or 0.9% saline, 30 min before induction. Sevoflurane anaesthesia was titrated to bispectral index 40-60. The primary outcome was the incidence of emergence agitation (Riker sedation agitation scale score ≥ 5 from sevoflurane discontinuation to 5 min post-tracheal extubation). We recruited 159 patients (median (IQR [range]) age 50 (36-60 [18-77]) y; 62% male). The incidence of emergence agitation in patients allocated to the dexmedetomidine group was 25% (20/80) compared with 47% (37/79) in those allocated to the 0.9% saline group (RR 0.53, 95%CI 0.34-0.82, p = 0.004), with a number needed to treat of 4.6. Secondary and exploratory outcomes showed that dexmedetomidine nasal spray was associated with: less venepuncture pain; reduced rate of sleep disturbance on the first night after surgery; and higher patient satisfaction, without increasing adverse events. Pre-operative dexmedetomidine nasal spray reduced emergence agitation in adult patients undergoing ear, nose and throat surgery, and could enhance peri-operative care for these procedures.