The Impact of Preoperative Low-Dose Esketamine and Dexmedetomidine Nasal Administration on the Emergence Delirium in Children Undergoing Fiber Bronchoscopy: A Prospective Randomized Controlled Trial.

Preoperative nasal administration of low-dose esketamine or dexmedetomidine reduces emergence delirium after pediatric fiberoptic bronchoscopy. In a randomized trial of 126 children aged 1–6 years, emergence delirium occurred in 7.14% of those given 1.0 mg/kg esketamine and 18.6% of those given 1.0 μg/kg dexmedetomidine, compared with 48.78% in the saline control group. Both drugs also lowered postoperative pain intensity. Dexmedetomidine prolonged the time to awaken and open eyes in the recovery unit, while hemodynamics, oral secretions, and recovery-stay duration did not differ among groups.

Study at a glance

Abstract

This study aimed to investigate the effects of preoperative low-dose esketamine and dexmedetomidine nasal administration on the incidence of postoperative emergence delirium in children undergoing fiber bronchoscopy. A total of 129 patients, of any gender, aged 1 to 6 years, with ASA grades I and II, who were scheduled for fiber bronchoscopy, were randomly divided into three groups (n = 43) using a random number table method: 1.0 mg/kg of esketamine, 1.0 μg/kg of dexmedetomidine, and an equal volume of normal saline (group control). The respective dose of the drug or normal saline was rapidly instilled through both nostrils using a 1-mL syringe. The primary outcome measure was the incidence of emergence delirium. The secondary outcome measures included postoperative pain intensity, time to awaken and open eyes in the postanesthesia care unit, incidence of postoperative adverse behavior, hemodynamics, and duration of stay in the postanesthesia care unit. A total of 126 patients completed the study, and compared with the group control (48.78%), the 1.0 mg/kg esketamine (7.14%) and 1.0 μg/kg dexmedetomidine (18.6%) had a lower incidence of postoperative emergence delirium ( P < 0.01), as well as lower postoperative pain intensity ( P < 0.01). However, compared with the group control, the 1.0 μg/kg dexmedetomidine had a prolonged time to awaken and open eyes in the postanesthesia care unit ( P < 0.05). The duration of hemodynamics, oral secretion volume, and stay in the postanesthesia care unit were similar among the three groups. The findings suggest that low-dose esketamine and dexmedetomidine can reduce the incidence of emergence delirium.