Dexmedetomidine Use in the Pediatric Postoperative Patient with Emergence Agitation: A Systemic Review

Emergence Agitation is a frequent complication in the pediatric postoperative population; with up to 80% incidence (Stamper, Hawks, Taicher, Bonta & Brandon, 2014). These patients will present with crying, overexcitement, thrashing, agitation and is seen within the first 30 minutes of emergence of general anesthesia (Mohkamkar, Farhoudie, Alam-Sahebpour, Mousavi, Khani & Shamomhammadi, 2014). Dexmedetomidine, a selective alpha 2 agonist, reduces norepinephrine output, initiates firing of inhibitory neurons such as the gama aminobutric acid system and reduces release of substance P and other catecholamines. These actions provide the patient with sedation, analgesia, and anesthesia (Nagelhout & Elisha, 2018). Due to the mechanism of action of dexmedetomidine, bradycardia and hypotension have been seen in pediatric patients. This has put a limit on the use of dexmedetomidine in this population. The purpose of this systematic review was to examine efficacy and side effects of various doses of dexmedetomidine to prevent emergence agitation in the pediatric postoperative patient. A comprehensive literature review was completed with the use of CINAHL Plus with full text, PubMed and Google Scholar. Preferred Reporting Items for Systematic Meta-Analysis (PRISMA), was used as guidelines to assist in proper identification of articles. The quality and critical appraisal of each randomized control trial was determined by the Critical Appraisal for Summaries of Evidence (CASE) worksheet. A cross study analysis table was created and used to analyze results of all studies. The findings of this systematic review determined dexmedetomidine was beneficial in emergence agitation prevention. Dexmedetomidine dosed at 0.5 mcg/kg-1mcg IV boluses and 1 mcg/kg – 2 mcg/kg intranasal sprays provided good relief with limited adverse effects.