title: Effect of dexmedetomidine on preventing agitation and delirium after microvascular free flap surgery: a randomized, double-blind, control study.
abstract: OBJECTIVE
  To determine whether dexmedetomidine sedation in the postanesthesia care unit (PACU) could decrease agitation and delirium after free flap surgery.
  
  
  METHODS
  Eighty patients were randomly divided into 2 groups. In the experimental group, dexmedetomidine was given at an hourly infusion rate of 0.5 μg/kg for 1 hour before the operation was completed and continued in the PACU at 0.2 to 0.7 μg/kg continuously until the next morning. In the control group, normal saline was given during the same periods. Patients in the 2 groups received sufentanil and midazolam for sedation and pain relief when necessary. Agitation was monitored with the Riker Sedation-Agitation Scale in the PACU and delirium was monitored with the Confusion Assessment Method for the Intensive Care Unit for 5 days postoperatively.
  
  
  RESULTS
  The overall incidence of agitation was similar between the 2 groups. However, when the influence of patient shifting was excluded, the incidence of agitation in the dexmedetomidine group was apparently lower than that in the control group (10.3 vs 30%; P = .029). No difference was found in the occurrence of delirium between the experimental and control groups (5.1 vs 12.5%; P = .432).
  
  
  CONCLUSIONS
  Dexmedetomidine does not change the overall incidence of agitation after free flap surgery; however, it does decrease agitation after PACU admission. It does not prevent delirium within 5 days postoperatively.
authors.affiliation: Associate Chief, Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China. Electronic address: kqyangxudong@163.com.
authors.forename: Xudong
authors.initials: X
authors.lastname: Yang
authors.affiliation: Resident, Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Nurse Anesthetist, Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Gao
authors.affiliation: Chief, Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, China.
authors.forename: Ruichang
authors.initials: R
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D001794:Blood Pressure / Q000187:drug effects; D003693:Delirium / Q000517:prevention & control*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011229:Preanesthetic Medication / Q000379:methods*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012890:Sleep / Q000187:drug effects; D017409:Sufentanil / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010919:Placebos; D020927:Dexmedetomidine; D017409:Sufentanil; D008874:Midazolam