title: Tracheal extubation in deeply anesthetized pediatric patients after tonsillectomy: a comparison of high-concentration sevoflurane alone and low-concentration sevoflurane in combination with dexmedetomidine pre-medication.
abstract: Dexmedetomidine can facilitate a smooth extubation process and reduce the requirement of sevoflurane and emergence agitation when administrated perioperatively. We aimed to observe the extubation process and the recovery characteristics in pediatric patients undergoing tonsillectomy while anesthetized with either high-concentration sevoflurane alone or low-concentration sevoflurane combined with pre-medication of single dose of intravenous dexmedetomidine.
  
  
  
  Seventy-five patients (ASA I or II, aged 3-7 years) undergoing tonsillectomy were randomized into three equal groups: to receive intravenous saline (Group D0), dexmedetomidine 1 μg/kg (Group D1), or dexmedetomidine 2 μg/kg (Group D2) approximately 10 min before anesthesia. Before the end of surgery, sevoflurane were adjusted to 1.5 times, 1.0 time and 0.8 times the minimal effective concentration in groups D0, D1and D2, respectively. The sevoflurane concentration for each group was maintained for at least 10 min before the tracheal deep-extubation was performed. The extubation event, recovery characteristics and post-op respiratory complications were recorded.
  
  
  
  All tracheal tubes in three groups were removed successfully during deep anesthesia. Nine patients in Group D0, three patients in Group D1, and two patients in Group D2required oral airway to maintain a patent airway after extubation. The frequency of oral airway usage in groups D1and D2were significantly lower than that in Group D0. The percentages of patients with ED and the requirements of fentanyl in groups D1and D2were also significantly lower than those in Group D0. The time from extubation to spontaneous eye opening in Group D2was longer than that in groups D0and D1. The times of post-anesthesia care unit discharge in groups D0and D2were longer than that in Group D1. No other respiratory complications and vomiting were observed.
  
  
  
  A single dose of intravenous dexmedetomidine as pre-medication in combination with low-concentration sevoflurane at the end of surgery provided safe and smooth deep extubation condition and it also lowered the emergence agitation in sevoflurane-anaesthetized children undergoing tonsillectomy. Preoperative dexmedetomidine at 1 μg/kg did not prolong postoperative recovery time.
  
  
  
  Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16008423 , date of registration: 06 may 2016.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Meiqin
authors.initials: M
authors.lastname: Di
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Zhuqing
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Huacheng
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China.
authors.forename: Wangning
authors.initials: W
authors.lastname: ShangGuan
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, 325027, People's Republic of China. lianqingquanmz@163.com.
authors.forename: Qingquan
authors.initials: Q
authors.lastname: Lian
mesh_terms: D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D000071257:Emergence Delirium / Q000517:prevention & control; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D011292:Premedication; D000077149:Sevoflurane; D014068:Tonsillectomy
chemical_list: D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D020927:Dexmedetomidine
keywords: Deep tracheal extubation; Dexmedetomidine; Pediatric; Sevoflurane