Comparative study between prophylactic single dose of fentanyl and dexmedetomidine in the management of agitation after sevoflurane anesthesia in children

Objective
The higher incidence of post sevoflurane agitation presents a great dilemma. This controlled study was performed to test the hypothesis that the prophylactic single dose of either dexmedetomidine or fentanyl reduces the incidence of emergence agitation post sevoflurane anesthesia in children.
Patients and methods
Ninety pediatric patients were scheduled for elective surgical procedures under general anesthesia and caudal block. They were randomized to one of three groups (each one is 30 patients); fentanyl group (1 μg/kg), dexmedetomidine (DEX) group (0.15 μg/kg), and control group. Recovery was assessed by time until eye opening on command, pain was evaluated by the children’s and infants’ postoperative pain scale (CHIPPS) and adequacy of recovery was assessed using a Modified Aldert score. Both were recorded every 15 min. Behavior score was recorded in the pre- and postoperative periods.
Main results
Patients in control group obtained higher values (9.65 ± 0.34) in the modified Aldert score than patients who received fentanyl (9.58 ± 0.30) and dexmedetomidine (9.37 ± 0.37). There was significant difference between dexmedetomidine and fentanyl groups For pain assessment, patients in control group suffered from pain when measured by CHIPPS (0.93 ± 0.56) more than patients in dexmedetomidine group (0.48 ± 0.45) and fentanyl group (0.13 ± 0.35), with more significant pain in dexmedetomidine group when compared to fentanyl group ( < 0.05). As regard behavior during emergence, there were significant differences between the placebo with 40% agitation and both fentanyl group with 21.4% agitation ( = 0.002) and dexmedetomidine group with 16.7% agitation ( = 0.001), while there were no significant differences between fentanyl and dexmedetomidine group.
Conclusions
Incidence of postoperative agitation in pediatric patients receiving sevoflurane was decreased from 40% with placebo to 16.7% with dexmedetomidine and 21.4% with fentanyl with no significant differences between dexmedetomidine and fentanyl groups.