Dexmedetomidine in Reducing Incidence of Emergence Agitation After Nasal Surgery
Condition: Postoperative Delirium
MeSH terms: Emergence Delirium
Study type: Interventional
Phase: Phase 3

Summary: 
      Various pharmacological interventions have been attempted previously to prevent postoperative
      EA with variable results. These include use of opioids, propofol, midazolam, ketamine,
      magnesium and alpha-2 agonists like clonidine and dexmedetomidine. Dexmedetomidine have been
      used with different dosages and different timings of administration with variable results and
      at the expense of major hemodynamic disturbances. The objective of this study was to
      investigate the role of single dose of dexmedetomidine (0.5 mcg/kg) administered as 30
      minutes infusion prior to extubation in reducing the incidence and severity of EA and
      coughing on extubation.
    

Detailed description: 
      Emergence agitation (EA) or delirium is a post anesthesia complication which is manifested as
      confusion, agitation, disorientation and aggressive behavior. It can lead to serious
      consequences including hemorrhage, removal of lines, drains and catheters, self-extubation
      and even falling out of bed resulting in severe injuries. EA is associated with cognitive
      deficit, physical dependence, increased hospital stay and higher mortality.

      There is wide variation in the incidence of EA in scientific literature ranging from 5 % to
      27.3 %. There are no clear diagnostic criteria for EA because of its varied clinical
      manifestations. Although many risk factors have been identified including pain, presence of
      stress at the time of induction, induction with etomidate, use of premedication with
      benzodiazepines, hypoxemia, type of surgery, awakening in hostile and noisy environment and
      presence of urinary catheter. Patients undergoing nasal surgeries are in particular, at
      higher risk for EA due to a sense of suffocation secondary to nasal packing.

      Various pharmacological interventions have been attempted previously to prevent postoperative
      EA with variable results. These include use of opioids, propofol, midazolam, ketamine,
      magnesium and alpha-2 agonists like clonidine and dexmedetomidine. Dexmedetomidine have been
      used with different dosages and different timings of administration with variable results and
      at the expense of major hemodynamic disturbances. The objective of this study was to
      investigate the role of single dose of dexmedetomidine (0.5 mcg/kg) administered as 30
      minutes infusion prior to extubation in reducing the incidence and severity of EA and
      coughing on extubation.
    

Intervention name(s): Dexmedetomidine
Intervention type(s): Drug
Intervention description(s): Intravenous dexmedetomidine will be administered 45 minutes before extubation in intervention group
Other intervention name(s): Control
Intervention MeSH terms: Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention