A COMPARATIVE STUDY OF DEXMEDETOMIDINE AS BOLUS OR LOW-DOSE INFUSION FOR PREVENTION OF EMERGENCE AGITATION AFTER SEVOFLURANE IN PAEDIATRIC ANAESTHESIA

Abstract

Background: Emergence agitation (EA) is a common and distressing complication following sevoflurane anaesthesia in paediatric patients, characterized by non-purposeful restlessness, crying, and disorientation. Dexmedetomidine, a highly selective α2-agonist, is frequently utilized to prevent EA. However, the optimal administration method, rapid intravenous bolus versus continuous intraoperative infusion, remains debated regarding the balance of efficacy and hemodynamic stability. Aims and Objectives: To systematically compare the clinical effectiveness, postoperative recovery profile, and perioperative hemodynamic stability of a rapid bolus versus a continuous low-dose infusion of dexmedetomidine (0.3 µg/kg) in preventing emergence agitation in children undergoing elective abdominal and genitourinary surgeries under sevoflurane anaesthesia. Materials and Methods: This prospective, randomized, double-blind, comparative study enrolled 80 paediatric patients (ASA physical status I–II, aged 2–12 years) randomly allocated into two equal groups (n=40). Group B received IV dexmedetomidine 0.3 µg/kg as a bolus over 10 minutes; Group I received a continuous infusion at 0.3 µg/kg/hour. Intraoperative Heart Rate and MAP were continuously monitored. Postoperative emergence agitation and pain were assessed using the PAED scale and Observational Pain Scores (OPS) in the PACU. Results: Both techniques provided comparable hemodynamic stability. A transient, statistically significant decrease in MAP (p=0.015) was noted at 10 minutes post dexmedetomidine administration in group B, accompanied by a mild, non significant reduction in heart rate (p=0.184); all values remained within 20% of pre-induction baselines without requiring intervention. Group B demonstrated superior early analgesia (OPS on PACU arrival: 1.8 ± 1.2 vs 4.6 ± 1.8; p<0.001). Extubation times (6.2 ± 1.1 vs 6.5 ± 1.4 min; p=0.284) and emergence times (8.1 ± 1.5 vs 8.4 ± 1.8 min; p=0.418) were highly comparable. Conclusion: A 0.3 µg/kg bolus of dexmedetomidine is hemodynamically safe and clinically superior to an equivalent continuous infusion. It provides good early postoperative analgesia and effectively mitigates sevoflurane-induced emergence agitation without extending recovery or extubation times.