Dexmedetomidine-Based Anesthesia for Pediatric Adenotonsillectomy: A Retrospective Observational Case Series

Abstract

Background Tonsillectomy is a surgical procedure primarily aimed at the removal of the tonsils, which are lymphoid tissues located at the back of the throat. This procedure is commonly indicated for conditions such as recurrent tonsillitis, chronic tonsillitis, or obstructive sleep-disordered breathing resulting from enlarged tonsils, which is often conducted under general anesthesia. The purpose of this research is to assess the safety and efficacy of dexmedetomidine-based anesthesia with minimal opioid supplementation in children undergoing adenotonsillectomy. Methods We studied pediatric patients who underwent adenotonsillectomy as a day case from March 2024 to September 2024. We reviewed patients who received dexmedetomidine as the primary analgesic agent, with minimal supplemental opioid use, intravenously after standard inhalation of anesthesia and after the surgery. The dose was determined by the anesthesiologist based on age, weight, and anesthetic requirements. There was no fixed institutional protocol for dose standardization. For pain assessment, we used the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale. We looked at any patient who required postoperative analgesia in the post-anesthesia care unit (PACU). We reviewed cases conducted in the pediatric operating room and recovery unit at King Abdullah Specialized Children Hospital in Riyadh, Saudi Arabia. While FLACC is validated for patients aged two months to seven years, it was used in all patients due to institutional practice. This is acknowledged as a limitation. Results A total of 51 pediatric patients were included in this study. The study population was divided into three age groups: Group 1 (<3 years, n = 12), Group 2 (>3 to <7 years, n = 21), and Group 3 (>7 years, n = 18). This age-based stratification was used to assess whether patient age influenced postoperative outcomes such as pain scores, recovery duration, or oxygen requirements. The mean dose of dexmedetomidine (Precedex) administered intraoperatively was 0.66 mcg/kg (range: 0.16-1.4), while the mean fentanyl dose was considerably lower at 0.17 mcg/kg (range: 0.00-3.0), indicating minimal reliance on opioids. Spearman correlation analysis did not reveal any statistically significant associations between the primary independent variables (Precedex dose, fentanyl dose, surgery duration, and age group) and the postoperative outcomes of interest. Conclusion This retrospective case series suggests that dexmedetomidine may offer a feasible opioid-sparing approach to postoperative analgesia in pediatric adenotonsillectomy. However, due to the small sample size and lack of a control group, conclusions about efficacy should be interpreted with caution.

Keywords: opioids; pediatric adenotonsillectomy; pediatric obstructive sleep apnea; postoperative pain control; dexmedetomidine.

Figure 1. Graph demonstrating a general trend of pain scores in patients receiving dexmedetomidine and those receiving dexmedetomidine and fentanyl

Figure 2. Distribution of pain scores by Precedex only.