Impact of different routes of administrations of dexmedetomidine on children during the process of recovery from anesthesia

Objective To compare the impacts of intranasal and intravenous administration of dexmedetomidine on the process of recovery from general anesthesia with sevoflurane inhalation in pediatric patients undergoing laparoscopic inguinal hernia ligation. Methods A total of 90 patients undergoing laparoscopic inguinal hernia ligation in the First Affiliated Hospital of University of Science and Technology of China between October 2017 to December 2018 were randomly divided into intravenous administration group (VD group), intranasal administration group (ND group), and control group (C group), with 30 cases in each group. Before anesthesia Induction, the VD group received intravenous administration of dexmedetomidine (0.5 μg/kg) combined with intranasal administration of 0.5 mL saline; The ND group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2.0 μg/kg); The C group received intravenous administration of 0.5 mL saline combined with intranasal administration of dexmedetomidine (2 μg/kg). The operation time, the time to extraction of laryngeal mask and the time stay in recovery room were recorded. The Pediatric anesthesia Emergence Delirium Scale (PAED) score and Ramsay score were used to evaluate the levels of sedation at 5 min, 10 min and 30 min after waking up. The blood pressure, heart rate, oxygen saturation and adverse reactions of patients were also recorded before surgery, 10 min after surgery, and at the end of the surgery. Results There were no significant differences in the operation time and PACU stay time among the three groups. The PAED scores in group C were higher than group VD and group ND at 5 min, 15 min and 30 min after the patients waking up (all P＜0.05), and the levels of sedation in VD and ND decreased. The Ramsay scores of group C were lower than group VD and group ND (all P＜0.05). The heart rate at 10 min after surgery and the end of surgery in VD group decreased more obviously as compared with ND group and C group (all P＜0.05), but still within the safe range. No respiratory depression occurred in all the three groups. Conclusion Administration of dexmedetomidine via venous and nasal can provide a satisfactory sedation and delirium effect for children with laparoscopic hernia surgery. Intranasal administration of dexmedetomidine had fewer side effects on heart rate as compared with intravenous administration.