Dexmedetomidine cuts perioperative respiratory adverse events in tonsillectomy

Among children undergoing elective tonsillectomy and adenoidectomy, the incidence of perioperative respiratory adverse events (PRAEs) is reduced for those receiving premedication with intranasal dexmedetomidine, according to a study.

Fangming Shen, M.D. and colleagues examined the effect of premedication with intranasal dexmedetomidine or midazolam on the occurrence of PRAEs among children aged 0 to 12 years undergoing elective tonsillectomy and adenoidectomy from October 2020 to June 2021. Participants were randomly assigned to receive intranasal midazolam, intranasal dexmedetomidine, or intranasal saline for control (124, 124, and 125 children, respectively).

The researchers found that children in the midazolam group were more likely to experience PRAEs than those in the normal saline group, while those in the dexmedetomidine group were less likely to experience PRAEs (adjusted odds ratios, 1.99 and 0.45, respectively) after adjustment for confounders, including age, sex, American Society of Anesthesiologists physical status, body mass index, obstructive sleep apnea, upper respiratory tract infection, and passive smoking. The midazolam group had a higher risk for PRAEs compared with the dexmedetomidine group (adjusted odds ratio, 4.44), but no other serious clinical adverse events were seen.

"If there are no special contraindications, we recommend dexmedetomidine sedation before surgery for children undergoing tonsillectomy and adenoidectomy," the authors write.

I had this done when I was 7. All I can remember is a really, really mean nurse who wouldn’t allow any privacy in the bathroom and that I was told I could have as much ice cream as I wished. I have since considered that a lie because a.) no, I didn’t get much, and 2.) my throat hurt so bad I didn’t want to swallow. I felt cheated and lied to. I’ve never trusted the medical profession or my parents since.

This isnt really all that great of an article as it misses a lot of nuance. In an of it self, it takes an awful lot of versed (midazolam) to cause respiratory arrest. When paired with narcotic analgesics is when you tend to see synergistic respiratory depression and also hypotension. Precedex (dex) is a centrally acting alpha two agonist with its own challenges, namely pretty severe bradycardia and hypotension. It is a more rapid acting drug, and originally was advertised as the perfect airway management drug as it left respiratory drive alone, but anesthetized the patient. However, having tried to intubate a lot of patients under GA doses of dex, it was a pretty crappy experience.

The advantage dexemedetomidine has, and its main use, is as a secondary line of sedation in ventilated and critically ill patients. We have learned that benzodiazepines PROMOTE delirium, which is a really bad thing in a critically ill patient. Midazolam gives kids about 10% of the time emergence delirium which is pretty special to see. Even in adults who get versed as an amnestic, they emerge screwy about 10 % of the time as well.

Overall, When I used to anesthetize kids for Tonsillectomy it was an ether inhalation induction, start a line, give a little fentanyl and paralytic, let the surgeon cut, reverse paralytic, wake kid up by getting them breathing while still on volatile ethers, then perform a deep extubation. It was awfully smooth and with spontaneous respiration, it is pretty easy to titrate narcotic to the proper depth by keeping an eye on respiratory rate.

Kidde anesthesia is a real art, and pediatric anesthesiologists have the patience of job and the gentleness of a dove. They are amazing people for taking care of the little ones.

Generally, I am not a fan of dex in the intraoperative arena.

Thanks for the work you do in educating the forum on medical things I find your selections fascinating and pertinent. Keep up the good work!!

Regards!

I was six and, although I buzzed the nurse a time or two for ice cream, when she showed, I had lost all desire.

My throat hurt and was so parched for those days.

I remember fighting the surgeon in the operating room and then getting a scented air smell, as I went under.

It was an inappropriate operation. My wife still has her tonsils and adenoids.

Wish I did.

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