Nose or vein for dexmedetomidine after tonsil surgery?
In 139 children, IV 1 μg/kg and IN 2 μg/kg dexmedetomidine both lowered peak PAED vs saline (8.3 vs 10.3), but only IV slowed heart rate and prolonged PACU stay.
Source
Comparative evaluation of intravenous versus intranasal dexmedetomidine on emergence delirium and hemodynamics in pediatric patients undergoing adenotonsillectomy: a randomized controlled trial
Study at a glance
- Design
- RCT — Three-arm randomized trial of IV vs intranasal dexmedetomidine vs saline after induction for pediatric adenotonsillectomy (ChiCTR2200065404)
- N
- N=139 · 139 randomized children 3–10 years (IV DEX 47, IN DEX 47, control 45) after 141 screened
- Population
- Children 3–10 years undergoing elective adenotonsillectomy
- Outcome
- Highest PAED score in first 30 min after awakening; pain, awakening/PACU times, and perioperative heart rate
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What they did
Randomized 139 kids (3–10 y) after induction to IV dexmedetomidine 1 μg/kg, IN 2 μg/kg, or saline; primary outcome was highest PAED in 30 min after waking, plus pain, hemodynamics, and PACU time (ChiCTR2200065404).
What they found
Peak PAED 8.3 (IV) / 8.3 (IN) / 10.3 (control), P<0.001 vs control, no IV–IN difference early on. IN had lower PAED at 2 h and lower pain at 2–6 h. IV had longer wake/PACU times and lower perioperative HR.
The limits
What it doesn't show
Single-center adenotonsillectomy results may not generalize to other surgeries or unsedated IN premedication; PAED is a scale, not long-term neurodevelopment.
Key terms
- Emergence delirium
- Agitated, dissociated waking after anesthesia, common in children.
- PAED
- Pediatric Anesthesia Emergence Delirium score; primary outcome here.
- Dexmedetomidine
- Selective α2-agonist used IV 1 μg/kg or IN 2 μg/kg after induction.
- Adenotonsillectomy
- Tonsil/adenoid surgery that raises pediatric ED risk.
- PACU
- Post-anesthesia care unit; stay was longer after IV DEX.
- mCHEOPS
- Modified Children’s Hospital of Eastern Ontario Pain Scale.
Flashcards
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Common questions
How many children were randomized?
139 (47 IV, 47 IN, 45 saline).
What were the doses?
IV 1 μg/kg over 10 min vs IN 2 μg/kg.
Peak PAED vs control?
8.3 vs 10.3 (both DEX arms).
Which route spared HR?
Intranasal; IV lowered heart rate from baseline.
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