title: Emergence agitation prevention in paediatric ambulatory surgery: A comparison between intranasal Dexmedetomidine and Clonidine.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiology, N.R.S Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Anindya
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Anjan
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Sandip Roy
authors.initials: SR
authors.lastname: Basunia
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Surajit
authors.initials: S
authors.lastname: Chattopadhyay
authors.affiliation: Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Ratul
authors.initials: R
authors.lastname: Kundu
authors.affiliation: Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
authors.forename: Raghunath
authors.initials: R
authors.lastname: Bhattacharyya
keywords: Clonidine; Dexmedetomidine; emergence agitation; postanesthesia care unit