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• W1522208246 abstract "Bong et al. compared the effect of a single dose of dexmedetomidine or propofol on the incidence of emergence agitation in children undergoing magnetic resonance imaging (MRI) under general anaesthesia using sevoflurane 1. The authors reported that the administration of either agent was not associated with any significant decrease in the incidence of emergence agitation with sevoflurane. We would like to invite the authors to clarify some of the concerns we have about the study's methodology. Firstly, no premedication was given and the children did not receive any intra-operative opioids. Sevoflurane is associated with rapid emergence. Given these points, we are interested in how the children in the 0.9% saline group both tolerated insertion of an oral airway and had a mean (SD) emergence time of 20 (9) min, when mean emergence time (time to eye opening) of 8-10 min is more usual 2. Secondly, given that dexmedetomidine has an onset of action of < 5 min and peak effect within 15 min 3, we are not surprised that emergence agitation was not significantly more prevalent in Bong et al.'s study, in which the drug was administered 70 min before removal of the laryngeal mask. As their results contrast with a recently published meta-analysis on the pharmacological prevention of emergence agitation in children using α2-agonists 4, do the authors think that an adequate concentration of the drug was present in participants at the time of laryngeal mask removal? Emergence agitation usually occurs within the first 30 min after anaesthesia, with the highest incidence in first 5-15 min 5, 6. The authors, however, found a high incidence (39%) 20 min after anaesthesia, but did not mention the time of removal of any oral airway. Do they consider that this anomaly could explain why they found no difference in the prevalence of emergence agitation between propofol and dexmedetomidine? Finally, agitation was recorded only after spontaneous eye opening, but no sedation score was used to grade the degree of sedation after surgery. As sedation during emergence has been shown to affect the incidence of emergence agitation 4, how confident are the authors that their results could not be explained merely by varying levels of sedation between groups?" @default.
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• W1522208246 date "2015-06-09" @default.
• W1522208246 modified "2023-09-25" @default.
• W1522208246 title "Dexmedetomidine and emergence agitation" @default.
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• W1522208246 doi "https://doi.org/10.1111/anae.13116" @default.
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