Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium

Abstract

Presurgery anxiety in children may result in preoperative and postoperative complications. Emergence delirium (ED) is a mental disturbance common in children during recovery from general anesthesia. This study investigated the role of preoperative dexmedetomidine on parental separation anxiety and acceptance of wearing an anesthesia mask, and its effectiveness in reducing the incidence and severity of ED. A double-blind study was conducted in 41 children, aged 1 to 6 years, undergoing dental restoration and/or extractions. Subjects received 4 microg/kg of dexmedetomidine or 0.5 mg/kg of midazolam orally prior to anesthesia induction. Subjects' anxiety over parental separation, acceptance of anesthesia masks, and presence and severity of ED were evaluated. There were no statistically significant differences in parental separation anxiety or mask acceptance between the 2 groups. There were also no significant differences in ED occurrence. In this study, dexmedetomidine produced no common side effects (blood pressure and heart rate fluctuation), which may indicate that oral administration with a 76% bioavailability versus 82% in buccal preparations results in fewer side effects but requires higher dosing to gain therapeutic effects. Future studies should examine the use of higher doses of oral dexmedetomidine in reducing presurgical anxiety and postsurgical ED.