Dexmedetomidine use during strabismus surgery in agitated children.

OBJECTIVE We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. SUBJECTS AND METHODS We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 μg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 μg/kg and rocuronium bromide 0.5 mg/kg. RESULTS 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0-4.0) in group D and 0.0 (IQR 1.0-2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5-3.0) in group D and 2.0 (IQR 1.5-3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0-2.0) in group D and 4.5 (4.0-5.0) in group P] (p = 0.0001). CONCLUSION Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.