ABSTRACT
Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children during recovery from general
anesthesia and may result in postoperative complications. This study investigated safety and effectiveness of intranasal
dexmedetomidine in reducing the incidence and severity of EA.
Methods: This prospective, randomized double‑blinded controlled trial included 86 patients scheduled for the tonsillectomy
and/or adenoidectomy under general anesthesia with sevoflurane. They were randomly allocated into two groups. Group D
received intranasal dexmedetomidine at 1 μg/kg, and Group C received intranasal saline 0.9% after the induction of general
anesthesia. Four‑point agitation scale and Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain assessment
were measured at six time points (after extubation, leaving the operating room, on arrival to postanesthesia care unit [PACU],
10, 20, and 30 min after arrival in PACU). Extubation, emergence, and discharge times were recorded in addition to any
adverse effects.
Results: There was a significant difference in the incidence of EA between Groups D and C (6.98% and 58%, respectively,
with P = 0.001). The median four‑point agitation scales and the median scores of FLACC pain scales of Group D were
significantly lower than those of Group C at the all six time points with P < 0.05. Extubation, emergence, and discharge times
were comparable in both groups, and none of the subjects reported any adverse effects.
Conclusion: This study demonstrates that a 1 μg/kg dose of intranasal dexmedetomidine administered after the induction of
anesthesia reduces post‑sevoflurane incidence and severity of EA in children undergone tonsillectomy and/or adenoidectomy
with no adverse effects and smooth recovery profile.
Key words: Dexmedetomidine; emergence agitation; sevoflurane; tonsillectomy and adenoidectomy