Study Using Dexmedetomidine to Decreases Emergence Delirium in Pediatric Patients

Emergence delirium has been described as a dissociated state of consciousness in which the
child is irritable, uncompromising, uncooperative, incoherent, inconsolably crying, moaning,
kicking or thrashing. The children can run the gambit from restlessness and incoherence to
combative and psychotic. The incidence of emergence agitation or delirium is 80% after a
procedure with sevoflurane-induced anesthesia.

Dexmedetomidine has been shown to have sedative and analgesic effects. In the pediatric
population, it has been shown to provide sedation for radiographic procedures.
Intravenously, it is has been shown to decrease emergence delirium following sevoflurane
based anesthesia. The ability to administer a medication intranasally might solve the
problem of emergence delirium and emergence agitation posed by the young patients undergoing
myringotomy and tube placement.

Inclusion Criteria:

- ASA class 1 or 2 (healthy patient or acute illness)

- Parental willingness to participate

- Candidate for pressure-equalization tubes (PET) as determined by the ENT department

Exclusion Criteria:

- ASA class 3 or 4 (chronic illness or life-threatening illness)

- Parental refusal to participate

- Significant liver disease by history

- Allergy to dexmedetomidine or midazolam

- Nasal deformity

- Fever in the three days prior to surgery

- Nausea or vomiting

- History of hypertension

- History of cardiac dysfunction/disorder

- Diabetes mellitus