Comparatative Study Between Dexmedetomidine And Fentanyl For Analgesia And Prevention Of Emergence Agitation In Children Undergoing Cochlear Implantation

Document Type : Original Article

Authors

1 Department, of Anesthesia and intensive care, Fuclty of Medicine, Sohag University.

2 Department of, Anesthesia and intensive care, Fuclty of Medicine, Sohag University.

Abstract

Objective: This investigation aims to compare fentanyl with Dexmedetomidine as regards:
1. Their efficacy 2. Provide better quality of surgical field during cochlear implantation, including deliberate
hypotension.
3. The effect of both medications on postoperative pain.
4. Recovery time.
5. Emergence agitation. Patients and Methods:
The study was undertaken following the agreement of the Ethical Committee of Sohag University Hospital
and the acquisition of informed consent from the patient's parents.
Fifty juvenile patients (ASA I or II) scheduled for cochlear implantation were classified randomly into the
dexmedetomidine (D) and the fentanyl (F) groups. Anesthesia was initiated in group (D) with an intravenous
bolus of dexmedetomidine at a dosage of 2 µg/kg, administered slowly over 10 min, then a continuous
infusion at a rate of 0.7 µg/kg/h was conducted until the conclusion of the procedure. In the (F) group,
anesthesia was initiated by an intravenous administration of fentanyl at a dosage of 1 µg/kg over 10 minutes,
then a continuous infusion was conducted at a rate of 0.1 mg/kg/h. Subsequently, I.V. propofol and
atracurium are administered to both groups. We compared the two groups on a number of metrics, including
surgical field quality, intraoperative hemodynamics, recovery and discharge timelines, objective pain levels
after surgery, and the need for rescue analgesics and anti-emetics in the post-anesthesia care unit (PACU).
Results: The D group had a marginal reduction in heart rate (HR) compared to the fentanyl group. These
parameters were significantly reduced in the D group relative to the baseline throughout the operation. The
Modified Aldrete Score is superior in the D group compared to the F group.
A significant variation existed between both groups concerning the objective pain score. A significant
disparity existed between the two groups, with Group D exhibiting a more expedited recovery period
compared to Group F, rendering the data meaningful.
Conclusion: The infusion of dexmedetomidine during cochlear implantation in young individuals was more
effective in causing controlled hypotension. It facilitated swift recovery from anesthesia and diminished the use of analgesics in the PACU.

References

1. Aldrete JA. The post anesthesia recovery score revisited. J Clin Anesth 1995 ;7:89–91.
2. Ali A, El Ghoneimy M. Dexmedetomidine versus fentanyl as adjuvant to propofol: comparative study in children undergoing extracorporeal shock wave lithotripsy. Euro J Anesthesiol 2010;27:1058–64.
3. Bulow NM, Barbosa NV, Rocha JB. Opiod consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic video laparoscopic surgery. J Clin Anesth 2007;19:280–5.
4. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs 2007;67;7:1053–76.
5. Feld JM, Hoffman WE, Stechert MM, et al. Fentanyl or dexmedetomidine combined with desflurane for bariatricsurgery. J Clin Anesth 2006 ; 18:24–8.
6. Fromme GA, Mackenzie RA, Gould Jr AB, et al. Controlled hypotension for orthognathic surgery. Anesth Analg 1986;65(6):683–6.
7. Guler G, Akın A, Tosun Z, et al. A Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anesthesiol Scand 2005; 49:1088–91.
8. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: Part I Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004;101:1066–76.
9. Hofer RE, Sprung J, Sarr MG, et al. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth 2005; 52; 2:176–80.
10. Koroglu A, Demirbilek S, Teksan H, et al. Sedative, hemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth 2005; 94; 6:821–4.
11. Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesthesia Analg 1998; 87; 1:52–6.
12. Mason KP, Zgleszewski SE, Dearden JL, et al. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg 2006; 103:57–62.
13.Morgan EG, Mikhail MS, Murray MJ. Clinical anesthesiology,5th ed., vol. 37. New York: Lange Medical Books/McGraw-Hill; 2006
14. Nelson LE, Lu J, Guo T, et al. The alpha 2 adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98:428–36.
15. Pedersen CB, et al. Results and experiences with 55 cochlear implantations. Ugeskr Laeger 2000;162;0:5346–50.
16. Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulphate. Br J Anaesth 2009;103;4:490–5.
17. Tanskanen PE, Kytta JV, Randell TT, et al. Dexmedetomidine as an anesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo controlled study. Br J Anaesth 2006;97;6:658–65.
18. Turgut N, Turkmen A, Gokkaya S, et al. Dexmedetomidine based versus fentanyl-based total intravenous anesthesia for lumber laminectomy. Minerva Anesthesiol 2008;74:469–74.
19. Xu M, Kontinen VK, Kalso E. Effects of radolmidine, a novel alpha 2-adrenergic agonist compared with dexmedetomidine in different pain models in the rat. Anesthesiology 2000; 93: 473–81.

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