title: Appropriate dose of dexmedetomidine for the prevention of emergence agitation after desflurane anesthesia for tonsillectomy or adenoidectomy in children: up and down sequential allocation.
abstract: BACKGROUND
  Dexmedetomidine can be used for the prevention of emergence agitation (EA) in children. However, an inadequate dose of dexmedetomidine can induce prolonged sedation and cardiovascular complications. The aim of this study was to evaluate the effective dose of dexmedetomidine for the prevention of EA after desflurane anesthesia for patients undergoing a tonsillectomy or adenoidectomy.
  
  
  METHODS
  We enrolled 21 unpremedicated children, between 2 and 12 years, undergoing either a tonsillectomy or an adenoidectomy. General anesthesia was induced using sevoflurane and oxygen, and dexmedetomidine was administered before surgery. Anesthesia was maintained using desflurane resulting in a BIS range of 40-60. In the postanesthetic care unit (PACU), EA (agitation measured at level 4 or more at least once) was assessed on arrival in the PACU,15 min later, and 30 min later. The dose of dexmedetomidine for consecutive patients was determined by the response of the previous patient, using an increment or decrement of 0.1 μg/kg.
  
  
  RESULTS
  The 50% effective dose of dexmedetomidine for prevention of EA was 0.25 μg/kg (95% confidence limits, 0.17-0.33 μg/kg), and the 95% effective dose was 0.38 μg/kg (95% confidence limits, 0.29-0.39 μg/kg).
  
  
  CONCLUSIONS
  For prevention of EA after desflurane anesthesia for 50% and 95% of children undergoing tonsillectomies or adenoidectomies, 0.25 μg/kg or 0.38 μg/kg of dexmedetomidine is suggested. Further study is needed to validate the suggested dose of dexmedetomidine to prevent the EA that was identified in the present study.
  
  
  BACKGROUND
  Clinical Research Information Service KCT0000126 .
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 101 daehang-ro, jongno-gu, Seoul, 110-744, Republic of Korea. dami0605@snu.ac.kr.
authors.forename: Hee-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea. jinoben@naver.com.
authors.forename: Hyo-Jin
authors.initials: HJ
authors.lastname: Byon
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Inha University, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon, 400-711, Republic of Korea. anipics@naver.com.
authors.forename: Jong-Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, 156-755, Seoul, Republic of Korea. dada822@naver.com.
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 101 daehang-ro, jongno-gu, Seoul, 110-744, Republic of Korea. muslab@hanmail.net.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 101 daehang-ro, jongno-gu, Seoul, 110-744, Republic of Korea. kimjintae73@dreamwiz.com.
authors.forename: Jin-Tae
authors.initials: JT
authors.lastname: Kim
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D000077335:Desflurane; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D011595:Psychomotor Agitation / Q000517:prevention & control*; D000077149:Sevoflurane; D014068:Tonsillectomy / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D020927:Dexmedetomidine; D000077335:Desflurane; D007530:Isoflurane