Volume 29, Issue 5, 2020
DOI: 10.24205/03276716.2020.1124
Comparison of Preoperative Sedation Effect of Dexmedetomidine Nasal Spray at Different Doses in Children with Cleft Palate
Abstract
Purpose: To compare the preoperative sedation effect of dexmedetomidine nasal spray at different doses in children in order to obtain an ideal nasal spray dose.
Methods: 60 children with cleft palate repair (ASA I-II class) aged 1-3 years old were enrolled in this study in virtue of the randomized, double-blind, controlled study methods. They were randomly divided into 4 groups: dexmedetomidine nasal spray 2.0 μg/kg group (YM2.0 group), dexmedetomidine nasal spray 2.5 μg/kg group (YM2.5 group), dexmedetomidine nasal spray 3.0 μg/kg group (YM3.0 group), and normal saline nasal spray group (Con group). In YM2.0 group, YM2.5 group and YM3.0 group, aerosol nasal sprayer was used to spray nose. Dexmedetomidines 2.0 μg/kg, 2.5 μg/kg, and 3.0 μg/kg were given respectively. In Con group, normal saline was given by nasal sprayer. Heart rate (HR), oxygen saturation (Sp O2) and ramsay sedation scores were recorded at pre-dose (T0), 5 min (T1), 10 min (T2), 15 min (T3), 20 min (T4), 25 min (T5) and 30 min (T6), respectively. Time of falling asleep was recorded, crying was known when relative was separated from the children, as well as struggling during induction of inhalation, and awakening time after discontinuation of general anesthesia. Parental satisfaction was assessed by a modified children's parent satisfaction scale after surgery.
Results: After administrating dexmedetomidine 2.0 μg/kg, children fell asleep about 15 min, and after administrating dexmedetomidine 2.5 μg/kg and 3.0 μg/kg, children fell asleep about 10 min. Dexmedetomidines 2. 5 μg/kg and 3. 0 μg/kg ramsay sedation score at the same time point after falling asleep were higher than that of dexmedetomidine 2.0 μg/kg (P <0.05). Most of the children who fell asleep after taking dexmedetomidine 2.0 μg/kg were awake and crying when they were separated from their relatives; most of the children who fell asleep after taking dexmedetomidines 2.5 μg/kg and 3.0 μg/kg were calm without waking up when they were separated from their relatives. Children who fell asleep after taking dexmedetomidine 2.0 μg/kg couldn't proceed sevoflurane induction silently; children who fell asleep after taking dexmedetomidines 2.5 μg/kg and 3.0 μg/kg could proceed sevoflurane induction silently so as to establish intravenous access. After discontinuation at the end of surgery, awakening time was longer with increasing dexmedetomidine dose; parental satisfaction was poor at dexmedetomidine 2.0 μg/kg, whereas parental satisfaction was satisfactory at dexmedetomidine 2.5 μg/kg; parents were slightly dissatisfied at dexmedetomidine 3.0 μg/kg. At dexmedetomidines 2.0 μg/kg, 2.5 μg/kg and 3.0 μg/kg, no serious complications such as low heart rate and respiratory depression were observed, and fewer adverse reactions such as crying reaction, bucking reaction and nausea and vomiting occurred during sedation.
Conclusion: Dexmedetomidine 2.5 μg/kg nasal spray is ideal for preoperative sedation, which can provide satisfactory sedation, less influence awakening, and better satisfy parents.
Keywords
Dexmedetomidine; Cleft palate repair; Pediatric; Sedation; Dose administered