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

BMC Anesthesiology

Research Article

Hongyan Lai¹  Meiqin Di¹  Huacheng Liu¹  Yuan Han¹  Wangning ShangGuan¹  Zhuqing Yang¹  Qingquan Lian¹  Jun Li¹  Xuefei Ye¹ 

[1] 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, 325027, Wenzhou, Zhejiang Province, People’s Republic of China;

关键词: Dexmedetomidine;    Deep tracheal extubation;    Sevoflurane;    Pediatric;   

DOI  :  10.1186/s12871-017-0317-3

 received in 2016-08-19, accepted in 2017-02-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDexmedetomidine 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.MethodsSeventy-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, D1 and 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.ResultsAll 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 D2 required oral airway to maintain a patent airway after extubation. The frequency of oral airway usage in groups D1 and D2 were significantly lower than that in Group D0. The percentages of patients with ED and the requirements of fentanyl in groups D1 and D2 were also significantly lower than those in Group D0. The time from extubation to spontaneous eye opening in Group D2 was longer than that in groups D0 and D1. The times of post-anesthesia care unit discharge in groups D0 and D2 were longer than that in Group D1. No other respiratory complications and vomiting were observed.ConclusionA 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.Trial registrationChinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16008423, date of registration: 06 may 2016.

【 授权许可】

CC BY   
© The Author(s). 2017