Dexmedetomidine vs remifentanil for reduction of postoperative agitation
Reviewed by Fiona Rowe

Postoperative agitation is a common anaesthetic complication in children with a significant impact to care and outcomes. The authors studied preschool children to compare the effect of intravenous administration of dexmedetomidine and remifentanil on postoperative agitation following strabismus surgery under sevoflurane anaesthetic. This was a randomised controlled trial of 60 children aged two - seven years. Usual anaesthetic procedures were followed and, at the end of surgery and anaesthetic, patients received either 0.5ugr/kg dexmedetomidine diluted with saline to a volume of 10cc or 0.1ugr/kg remifentanil diluted with saline to a volume of 10cc or control with 10cc of normal saline. There were 20 patients in each group. The groups were homogenous for age, sex, weight, duration of anaesthesia, surgery and duration of waking from anaesthesia. The paediatric anaesthesia emergence delirium scale was used as an outcome measure. Patients with active intervention had significant lower scores than the control group. Lowest agitation was with dexmedetomidine which was significantly lower than remifentanil. Using the children’s and infants postoperative pain scale, patients pain measured significantly less with dexmedetomidine than for remifentanil and controls. In recovery, all patients in the control group, 14 in the remifentanil group and four in the dexmedetomidine group received apotel. The dexmedetomidine group had significantly decreased need for analgesic. None of the patients in the active intervention groups received propofol for management of agitation vs all in the control group. Heart rate in the dexmedetomidine group at 20 and 30 minutes was significantly decreased compared to baseline at the time of extubation. This was significantly lower than remifentanil and control groups. There was excellent staff satisfaction with patient recovery at 95% for the dexmedetomidine group and 10% for remifentanil with good satisfaction at 80% for the latter group. The results indicate the use of dexmedetomidine significantly decreases the incidence of postoperative agitation vs controls and remifentanil. Dexmedetomidine was significantly more effective than remifentanil.

The effect of post-anesthetic administration of dexmedetomidine vs remifentanil on postoperative agitation of strabismus surgery in children: a randomised double-blind clinical trial.
Sahmeddini MA, Jamshidi M, Panah A, et al.
STRABISMUS
2024;32(4):243–51.