Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery: A randomized double-blind trial.
BACKGROUND
Postoperative emergency agitation (EA) is a common problem. Dexmedetomidine and remifentanil may be used to prevent this problem. Our primary aim was to compare dexmedetomidine, remifentanil, and placebo with respect to their effectiveness in preventing postoperative EA.


METHODS
Ninety patients undergoing nasal surgery were randomized into three groups. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion at a rate of 0.4 μg kg(-1 ) h(-1); the remifentanil group (group R, n = 30) received remifentanil infusion at a rate of 0.05 μg kg(-1) min(-1) from induction of anesthesia until extubation; and the control group (group S, n = 30) received a volume-matched normal saline infusion as a placebo. Propofol (1.5-2 mg kg(-1)) and fentanyl (1 μg kg(-1)) were used to initiate anesthesia, and desflurane was used to maintain anesthesia. The incidence of agitation, hemodynamic parameters, and recovery characteristics were evaluated during emergence.


RESULTS
The incidence of EA was significantly higher in group S (46.7%) compared with groups R and D (3.3 and 20%, respectively; p < 0.001). The lowest incidence of EA was detected in group R (p = 0.046). Residual sedation in the post-anesthesia care unit (PACU) was similar in all groups (p = 0.947). The incidence of nausea or vomiting was significantly lower in group D than in groups R and S (p = 0.043). Administration of analgesics in the PACU was higher in group R than in groups S and D (p = 0.015).


CONCLUSIONS
Anesthetic maintenance with either remifentanil or dexmedetomidine infusion until extubation provided a more smooth and hemodynamically stable emergence, without complications after nasal surgery. While remifentanil was superior to dexmedetomidine with regard to avoiding EA, dexmedetomidine was more effective than remifentanil regarding vomiting and pain.
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey. reyhanp9@gmail.com.
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Polat
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.
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Peker
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.
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Baran
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.
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Bumin Aydın
Fen Faculty Statistics Department, Bartin University, Bartin, Turkey.
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Topçu Gülöksüz
Ministry of Health, Department of Anesthesiology Diskapi, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey.
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Dönmez
D000293:Adolescent; D000328:Adult; D000368:Aged; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000379:methods*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D000077208:Remifentanil; D055815:Young Adult
D006993:Hypnotics and Sedatives; D010880:Piperidines; D020927:Dexmedetomidine; D000077208:Remifentanil
Anesthesia; Dexmedetomidine; Emergence agitation; Nasal surgery; Remifentanil