The sedative effects and the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation in pediatric patients: a randomized comparison between two different doses of preoperative intranasal dexmedetomidine.
OBJECTIVE
Premedication with intranasal dexmedetomidine (DEX) has shown to be an effective sedative in pediatric patients. This prospective, randomized, and controlled investigation was designed to evaluate whether the difference in intranasal DEX dosing would produce different beneficial effects on the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation.


METHODS
Forty children, aged from 3 to 6 years, of American Society of Anesthesiologists physical status I or II and scheduled for elective adenotonsillectomy randomly received intranasal DEX 1 μg·kg(-1) (group D1) or 2 μg·kg(-1) (group D2) 30 min before anesthesia induction. Anesthesia was induced with sevoflurane in oxygen flow. Mean arterial pressure (MAP) and heart rate (HR) as measurements of cardiovascular response and bispectral index (BIS) as an index of arousal response were recorded every 5 min after intranasal DEX administration and measured every 1 min for 5 min after intubation. Sedation status, behavior scores, and mask induction scores were also assessed.


RESULTS
Mean arterial pressure did not show statistical differences during the anesthesia induction, but did demonstrate significantly milder responses to laryngoscopy and intubation in group D2 compared with group D1. Change in HR was consistent with MAP during laryngoscopy and intubation. Patients who received 2 μg·kg(-1) DEX presented with deeper sedation and less anxiety by the assessments of the alertness scale, behavior score, and BIS scores. Group D2 dosing achieved more favorable scores in children undergoing mask induction.


CONCLUSIONS
Intranasal DEX 2 μg·kg(-1) administered 30 min before anesthesia induction provides considerable effect to attenuate the increase in MAP caused by intubation response. Changes in HR and BIS also demonstrate that this kind of premedication provides effective attenuation of intubation response. And preoperative intranasal DEX 2 μg·kg(-1) produces optimal-sedation, more favorable anesthesia induction course in pediatric patients. Premedication of intranasal DEX is a considerable way to blunt cardiovascular and arousal responses to endotracheal intubation.
Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shan-Shan
SS
Wang
Ma-Zhong
MZ
Zhang
Ying
Y
Sun
Chi
C
Wu
Wen-Yin
WY
Xu
Jie
J
Bai
Mei-Hua
MH
Cai
Lin
L
Lin
D000233:Adenoidectomy; D000281:Administration, Intranasal; D000758:Anesthesia; D001143:Arousal / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007442:Intubation, Intratracheal; D008297:Male; D011229:Preanesthetic Medication; D011446:Prospective Studies; D018401:Sample Size; D014068:Tonsillectomy
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
consciousness monitors; dexmedetomidine; hemodynamics; intranasal; intubation; pediatrics