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