Comparative study of the effect of two different doses of dexmedetomidine to prevent emergence agitation in tonsillectomy in children aged 2 to 12 years old


1 Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

2 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Emergence agitation (EA) is one of the complications following anesthesia in pediatric surgery. Various drugs are used to prevent this complication, and one of them is dexmedetomidine. Choosing the right dose of this drug for the best efficiency is an important issue due to this complication.The main purpose of this study is to evaluate the prophylactic effect of intravenous dexmedetomidine in different doses in preventing EA after tonsillectomy in children.
Materials and Methods: Our study was a double-blind clinical trial performed on 75 children ASAI, II candidates for tonsillectomy. Patients were divided into three groups. The group 1 received a dose of 0.6 μg/kg per hour and group 2 received a dose of 0.3 μg/kg per hour and group 3 was the control group. Then vital signs and observational pain score (OPS) and pediatric anesthesia emergence delirium (PAEDS) criteria were measured in patients. The collected data were analyzed by using SPSS software version 23 and non-parametric tests such as Friedman, Mann-Whitney.
Results: According to the data analysis, mean blood pressure, mean heart rate, OPS and PAEDS score in group 1 were lower than other groups. Also, the average time of staying in recovery and extubation in group 1 was less than other groups.
Conclusion: A dose of 0.6 μg/kg dexmedetomidine has a better effect on reducing EA (emergence agitation) after pediatric tonsillectomy.


Constant I, Seeman R. Inhalational anesthetics in pediatric anesthesia. Curr Opin Anesthesiol 2005;18:277-81.  Back to cited text no. 1
Kim H-S, Byon H-J, Kim J-E, Park Y-H, Lee J-H, Kim J-T. Appropriate dose of dexmedetomidine for the prevention of emergence agitation after desflurane anesthesia for tonsillectomy or adenoidectomy in children: Up and down sequential allocation. BMC Anesthesiol 2015;15:1-6.  Back to cited text no. 2
Rao Y, Zeng R, Jiang X, Li J, Wang X. The effect of dexmedetomidine on emergence agitation or delirium in children after anesthesia—A systematic review and meta-analysis of clinical studies. Front Pediatr 2020;8:329.  Back to cited text no. 3
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263-306.  Back to cited text no. 4
Begum U, Singh PR, Naithani B, Singh V, Singh GP, Tiwari T. Dexmedetomidine as bolus or low-dose infusion for the prevention of emergence agitation with sevoflurane anesthesia in pediatric patients. Anesth Essays Res 2019;13:57.  Back to cited text no. 5
[PUBMED]  [Full text]  
Mantz J, Josserand J, Hamada S. Dexmedetomidine: New insights. Eur J Anaesthesiol 2011;28:3-6.  Back to cited text no. 6
Chen J-Y, Jia J-E, Liu T-J, Qin M-J, Li W-X. Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children. Can J Anesth 2013;60:385-92.  Back to cited text no. 7
Ghai B, Ram J, Chauhan S, Wig J. Effects of clonidine on recovery after sevoflurane anaesthesia in children undergoing cataract surgery. Anaesth Intensive Care 2010;38:530-7.  Back to cited text no. 8
Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg 2010;111:1004-10.  Back to cited text no. 9
Bedirli N, Akçabay M, Emik U. Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: Prospective randomized controlled clinical study. BMC Anesthesiol 2017;17:1-7.  Back to cited text no. 10
Lee S. Dexmedetomidine: Present and future directions. Korean J Anesthesiol 2019;72:323-30.  Back to cited text no. 11
Mahmoud M, Mason KP. Dexmedetomidine: Review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth 2015;115:171-82.  Back to cited text no. 12
Garg A, Kamal M, Mohammed S, Singariya G, Chouhan DS, Biyani G. Efficacy of dexmedetomidine for prevention of emergence agitation in patients posted for nasal surgery under desflurane anaesthesia: A prospective double-blinded randomised controlled trial. Indian J Anaesth 2018;62:524-30.  Back to cited text no. 13
[PUBMED]  [Full text]  
Garg A, Kamal M, Mohammed S, Singariya G, Chouhan DS, Biyani G. Efficacy of dexmedetomidine for prevention of emergence agitation in patients posted for nasal surgery under desflurane anaesthesia: A prospective double-blinded randomised controlled trial. Indian J Anaesth 2018;62:524.  Back to cited text no. 14
[PUBMED]  [Full text]  
Random Allocation Software. Available from:  Back to cited text no. 15
Chang J, Versloot J, Fashler SR, McCrystal KN, Craig KD. Pain assessment in children: Validity of facial expression items in observational pain scales. Clin J Pain 2015;31:189-97.  Back to cited text no. 16
Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Pediatr Anesth 2010;20:704-11.  Back to cited text no. 17
Zhang C, Hu J, Liu X, Yan J. Effects of intravenous dexmedetomidine on emergence agitation in children under sevoflurane anesthesia: A meta-analysis of randomized controlled trials. PLoS One 2014;9:e99718.  Back to cited text no. 18
Zhang Y-Z, Wang X, Wu J-M, Song C-Y, Cui X-G. Optimal dexmedetomidine dose to prevent emergence agitation under sevoflurane and remifentanil anesthesia during pediatric tonsillectomy and adenoidectomy. Front Pharmacol 2019;10:1091.  Back to cited text no. 19
Mathur V, Trivedi PC, Garg DK, Khare A, Sethi S. Effect of intraoperative IV dexmedetomidine on emergence agitation after sevoflurane anaesthesia in children undergoing tonsillectomy with or without adenoidectomy. Indian J Clin Anaesth 2018;5:496-500.  Back to cited text no. 20
Ezz HAA. Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: A randomized clinical trial. Egyptian J Anaesth 2017;33:141-6.  Back to cited text no. 21
Elagamy AE, Mahran MG, Mahmoud AZ. Dexmedetomidine versus nalbuphine in prevention of emergence agitation following adenotonsillectomy in pediatrics. Egyptian J Anaesth 2020;36:24-9.  Back to cited text no. 22