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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1078-1082. doi: 10.19723/j.issn.1671-167X.2018.06.024

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Effects of intranasal dexmedetomidine for children undergoing dental rehabilitation under general anesthesia: a double-blinded randomized controlled trial

Ling GAO(),Yun LIU,Xu-dong YANG   

  1. Department of Anesthesiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2017-09-29 Online:2018-12-18 Published:2018-12-18
  • Contact: Ling GAO E-mail:gaolingwjx@163.com

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Abstract:

Objective: To observe the preoperative sedation, the status of separation from parents, compliance with the mask, hemodynamic parameters and postoperative agitation of intranasal dexmedetomidine (DEX) premedication on children undergoing dental rehabilitation under general anesthesia.Methods:In the study, 60 children of American Society of Anesthesiology classification (ASA Ⅰ-Ⅱ), aged 2-9 years, were randomly assigned to one of two equal groups. Thirty minutes before operation, control group received intranasal placebo (0.9% saline) 0.02 mL/kg, and DEX group received intranasal DEX 2 μg/kg. The preoperative sedation score, the status of separation from parents, comp-liance with the mask and hemodynamic parameters were recorded by an anesthesiologists until anesthesia induction. Recovery conditions, postoperative agitation were also recorded.Results:There was no signi-ficant difference between the two groups in patient characteristics, operation time, extubation time and recovery time. Compared with the children in control group, those in DEX group were significantly more sedated when they were separated from their parents (56.7% vs. 26.7%, P<0.05). Satisfactory compliance with mask application was 40% in control group vs. 73.3% in DEX group (P<0.05). There was no significant difference between the two groups regarding the incidences of postoperative agitation and oxygen saturation (SpO2). Compared with control group, the heart rate (HR) of DEX group was decreased after 20 minutes of drug administration [(97.13±12.93) beats/min vs.(104.53±11.97) beats/min, P<0.05]. The changes of the HR and SpO2 in the two groups were within the normal range. There were no incidences of bradycardia and hypoxemia in either of the groups during study observation.Conclusion:Premedication with intranasal DEX 2 μg/kg for children undergoing dental rehabilitation under general anesthesia produces good preoperative sedation. The levels of sedation, scores of parental separation and compliance with the mask were satisfied. The children have good recovery conditions, and no obvious postoperative agitation and respiratory depression after DEX administration. Intranasal DEX 2 μg/kg is an effective and safe alternative for premedication in children.

Key words: Dexmedetomidine, Administration, intranasal, Conscious sedation, Preoperative care, Child

CLC Number: 

  • R782.05

Figure 1

MAD100 mucosal atomization device"

Table 1

Ramsay sedation score"

Score Observation
1 Anxious, agitated, or restless
2 Cooperative, oriented, and tranquil
3 Responsive to commands
4 Asleep, but with brisk response to light glabellar tap or loud auditory stimulus
5 Asleep, sluggish response to glabellar tap or auditory stimulus
6 Asleep, no response

Table 2

The scores of separation from parents, compliance with the mask and postoperative agitation"

Score Separation Compliance with the mask Postoperative agitation
1 Combative, clinging Combative and angry Calm
2 Anxious, consolable Fear of the mask and not easily calmed Not calm but could easily be consoled
3 Calm Fear of the mask but easily calmed Not easily calmed, moderately agitated, or restless
4 Sleeping Calm and cooperative Combative, excited, or disoriented, thrashing around

Table 3

Basic information in the two groups"

Items Control group DEX group P
Age/months 43.60±12.92 46.20±10.07 0.403
Weight/kg 17.21±3.64 16.51±2.41 0.398
Male/Female 17/13 19/11 0.598
Operation time/min 177.50±33.91 181.33±39.10 0.661
Extubation time/min 5.07±1.68 5.93±2.03 0.114
Recovery time/min 25.77±12.63 29.50±12.40 0.432

Figure 2

The change chart of heart rate at different times in the two groups*P<0.05, **P<0.01, between the control group and DEX group."

Figure 3

The change chart of oxygen saturation (SpO2) at different times in the two groups"

Table 4

all the scores after administration in the two groups n(%)"

Control group DEX group P
Ramsay sedation score
Effective 0 18 (60.0) <0.001
Uneffective 30 (100.0) 12 (40.0)
Separation from parent
Satisfactory 8 (26.7) 17 (56.7) 0.018
Unsatisfactory 22 (73.3) 13 (43.3)
Compliance with mask
Satisfactory 12 (40.0) 22 (73.3) 0.009
Unsatisfactory 18 (60.0) 8 (26.7)
Postoperative agitation
Satisfactory 28 (93.3) 27 (90.0) 0.640
Unsatisfactory 2 (6.7) 3 (10.0)
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