Journal of Research in Pharmacy Practice

Emergence agitation prevention in paediatric ambulatory surgery: A comparison between intranasal Dexmedetomidine and Clonidine

Document Type : Original Article

Authors

. Anindya Mukherjee 1
. Anjan Das 2
. Sandip Roy Basunia 2
. Surajit Chattopadhyay 2
. Ratul Kundu 3
. Raghunath Bhattacharyya 2

1 Department of Anaesthesiology, N.R.S Medical College and Hospital, Kolkata, West Bengal, India

2 Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

3 Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Abstract
Objective: Emergence agitation (EA), a short‑lived, self‑limiting phenomenon, arises 
frequently after the use of inhalational agents and hampers the implementation of pediatric 
ambulatory surgery in spite of using so many drugs with variable efficacy.
Methods: In this prospective, double‑blinded, parallel group study (2008–2009), 80 children 
of both sex aged 3–7 years, with American Society of Anesthesiologists (ASA) physical status 
grade I-II, undergoing sevoflurane‑based general anesthesia for elective day care surgery 
were randomly assigned into groups C or D. Group C received 4 µg/kg intranasal clonidine, 
whereas group D received 1 µg/kg intranasal dexmedetomidine, 45 min before induction of 
anesthesia. In postanesthesia care unit (PACU), the incidence of EA was assessed with Aonos 
four‑point scale and the severity of EA was assessed with pediatric anesthesia emergence 
delirium scale upon admission (T0), after 5 min (T5), 15 min (T15), and 25 min (T25). 
Extubation time, emergence time, duration of PACU stay, dose and incidence of fentanyl 
use for pain control were noted.
Findings: Based on comparable demographic profiles, the incidence and severity of EA 
were significantly lower in group D as compared to group C at T0, T5, T15, and T25. But 
time of regular breathing, awakening, extubation, and emergence were significantly delayed in 
group D than C. The number and dose of fentanyl used in group C were significantly higher 
than group D. PACU and hospital stay were quite comparable between groups.
Conclusion: Intranasal dexmedetomidine 1 µg/kg was more effective than clonidine 
4 µg/kg in decreasing the incidence and severity of EA, when administered 45 min before the 
induction of anesthesia with sevoflurane for pediatric day care surgery. Dexmedetomidine 
also significantly reduced fentanyl consumption in PACU.

Keywords

Clonidine
Dexmedetomidine
emergence agitation
postanesthesia care unit
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Journal of Research in Pharmacy Practice
Volume 4, Issue 1
Winter 2015
Pages 24-30

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