Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study

Authors: Nurdan Bedirli, Mehmet Akçabay, Ulku Emik

Published in: BMC Anesthesiology | Issue 1/2017

Login to get access

Abstract

Background

This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia.

Methods

Seventy-seven patient, aged 2–12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded.

Results

Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D.

Conclusion

Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration.

Trial registration

Retrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016
Literature
1.
Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg. 2010;111:1004–10.PubMed
2.
Olutoye OA, Glover CD, Diefenderfer JW, Mcgilberry M, Wyatt MM, Larrier DR, et al. The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy. Anesth Analg. 2010;111:490–5.CrossRefPubMed
3.
De Luca Canto G, Pachêco-Pereira C, Aydinoz S, Bhattacharjee R, Tan HL, Kheirandish-Gozal L. Adenotonsillectomy Complications: A Meta-analysis. Pediatrics. 2015;136:702–18.CrossRefPubMed
4.
Ortiz AC, Atallah AN, Matos D, da Silva EM. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane Database Syst Rev. 2014;7:CD009015.
5.
Lerman J. Inhalation agents in pediatric anaesthesia-an update. Curr Opin Anaesthesiol. 2007;20:221–6.CrossRefPubMed
6.
Cole JW, Murray DJ, McAllister JD, Hirshberg GE. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr Anaesth. 2002;12:442–7.CrossRefPubMed
7.
Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials. Anesthesiology. 2008;109:225–32.CrossRefPubMed
8.
Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96:1625–30.CrossRefPubMed
9.
Sun L, Guo R, Sun L. Dexmedetomidine for preventing sevoflurane-related emergence agitation in children: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand. 2014;58:642–50.CrossRefPubMed
10.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.CrossRefPubMed
11.
12.
Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004;98:153–8.CrossRefPubMed
13.
Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015;11:171–82.CrossRef
14.
Peden CJ, Cloote AH, Stratford N, Prys-Roberts C. The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia. 2001;56:408–13.CrossRefPubMed
15.
Ingersoll-Weng E, Manecke Jr GR, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology. 2004;100:738–9.CrossRefPubMed
16.
17.
Chu YC, Lin SM, Hsieh YC. Intraoperative administration of tramadol for postoperative nurse-controlled analgesia resulted in earlier awakening and less sedation than morphine in children after cardiac surgery. Anesth Analg. 2006;102:1668–73.CrossRefPubMed
18.
Engelhardt T, Steel E, Johnston G, Veitch DY. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Paediatr Anaesth. 2003;13:249–52.CrossRefPubMed
19.
Van den Berg AA, Montoya-Pelaez LF, Halliday EM, Hassan I, Baloch MS. Analgesia for adenotonsillectomy in children and young adults: a comparison of tramadol, pethidine and nalbuphine. Eur J Anaesthesiol. 1999;16:186–94.CrossRefPubMed
20.
Schnabel A, Reichl SU, Meyer-Frießem C, Zahn PK, Pogatzki-Zahn E. Tramadol for postoperative pain treatment in children. Cochrane Database Syst Rev. 2015;18:CD009574.
21.
Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and illeoinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology. 1987;66:832–4.CrossRefPubMed
22.
Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138–45.CrossRefPubMed
23.
24.
Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain. 1998;75:37–45.CrossRefPubMed
25.
Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125–33.CrossRefPubMed
26.
Petroz GC, Sikich N, James M, van Dyk H, Shafer SL, Schily M, et al. A phase I, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology. 2006;105:1098–110.CrossRefPubMed
27.
Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha 2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003;98:428–36.CrossRefPubMed
28.
29.
30.
Umuroğlu T, Eti Z, Ciftçi H, Yilmaz Göğüş F. Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol. Paediatr Anaesth. 2004;14:568–73.CrossRefPubMed
31.
Marzuillo P, Calligaris L, Barbi E. Tramadol can selectively manage moderate pain in children following European advice limiting codeine use. Acta Paediatr. 2014;103:1110–6.CrossRefPubMed
32.
Radbruch L, Grond S, Lehmann KA. A risk-benefit assessment of tramadol in the management of pain. Drug Saf. 1996;15:8–29.CrossRefPubMed
33.
34.
Pestieau SR, Quezado ZM, Johnson YJ, Anderson JL, Cheng YI, Mccarter RJ, et al. High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children. Can J Anaesth. 2011;58:540–50.CrossRefPubMed
Metadata
Title
Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study
Authors
Nurdan Bedirli
Mehmet Akçabay
Ulku Emik
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0332-4

Other articles of this Issue 1/2017

BMC Anesthesiology 1/2017 Go to the issue

Research article

Comparison of the Supreme™ and ProSeal™ laryngeal mask airways in infants: a prospective randomised clinical study

Research article

Incidence and risk factors of chronic pain following hysterectomy among Southern Jiangsu Chinese Women

Research article

The value of arterial pressure waveform cardiac output measurements in the radial and femoral artery in major cardiac surgery patients

Case report

Acute transient spinal paralysis and cardiac symptoms following an accidental epidural potassium infusion – a case report

Research article

Effects of dexmedetomidine on TNF-α and interleukin-2 in serum of rats with severe craniocerebral injury

Correction

Correction to: Dexketoprofen/tramadol 25 mg/75 mg: randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy