Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial

  • Naveen, Naik B (Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research) ;
  • Jaiswal, Manoj Kumar (Department of Pedodontics and Preventive Dentistry, Post Graduate Institute of Medical Education and Research) ;
  • Ganesh, Venkata (Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research) ;
  • Singh, Ajay (Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research) ;
  • Meena, Shyam Charan (Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research) ;
  • Amburu, Vamsidhar (Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital) ;
  • Soni, Shiv Lal (Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research)
  • Received : 2022.08.17
  • Accepted : 2022.09.08
  • Published : 2022.10.01
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Abstract

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

Keywords

Acknowledgement

We would like to thank all pediatric patients and their parents/representatives who participated in this project.

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