Atomised intranasal dexmedetomidine versus oral melatonin in prevention of emergence delirium in children undergoing ophthalmic surgery with sevoflurane: A randomised double-blind study

BACKGROUND 

Melatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied.

OBJECTIVE 

To study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.

DESIGN 

A prospective, randomised, double-blind trial.

SETTING 

Ophthalmic surgery in a university teaching hospital, April 2021 to October 2021.

PATIENTS 

A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia.

INTERVENTION 

Children were randomised to receive pre-operative intranasal dexmedetomidine 2 μg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg−1 (melatonin group), 45 min before surgery.

OUTCOMES MEASURED 

The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain.

RESULTS 

The incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P = 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit (P < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0–4], (P = 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.

CONCLUSION 

Atomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin.

TRIAL REGISTRATION 

Clinical Trials Registry of India CTRI/2021/03/032388 (www.ctri.nic.in)

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