title: Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study.
abstract: This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia.
  
  
  
  Seventy-seven patient, aged 2-12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded.
  
  
  
  Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D.
  
  
  
  Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration.
  
  
  
  Retrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016.
authors.affiliation: Department of Anesthesiology, Gazi University Medical School, Kumeevler cad., Siyasal sit., No:44, 06810, Cayyolu, Ankara, Turkey. nurbedirli@yahoo.com.
authors.forename: Nurdan
authors.identifier: 0000-0003-2624-0259
authors.initials: N
authors.lastname: Bedirli
authors.affiliation: Department of Anesthesiology, Gazi University Medical School, Kumeevler cad., Siyasal sit., No:44, 06810, Cayyolu, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akçabay
authors.affiliation: Department of Anesthesiology, Gazi University Medical School, Kumeevler cad., Siyasal sit., No:44, 06810, Cayyolu, Ankara, Turkey.
authors.forename: Ulku
authors.initials: U
authors.lastname: Emik
mesh_terms: D000233:Adenoidectomy; D060666:Airway Extubation; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001919:Bradycardia / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage*; D000071257:Emergence Delirium / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D000077149:Sevoflurane; D014068:Tonsillectomy; D014147:Tramadol / Q000008:administration & dosage*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D014147:Tramadol; D020927:Dexmedetomidine
keywords: Dexmedetomidine; Pediatric recovery; Tramadol