Impact of Caudal Dexmedetomidine Versus Midazolam on Preventing Emergence Delirium after Sevoflurane Anesthesia in Pediatric Patients: A Prospective Randomized Trial

Abstract

Background: Postoperative emergence delirium (ED) is common in pediatric patients anesthetized with sevoflurane. ED carries many complications, such as disorientation and perceptual changes, including motor hyperactivity and hypersensitivity to stimuli. ED usually appears in the early 30 min after awakening from general anesthesia. We assessed the effect of caudal dexmedetomidine versus midazolam added to bupivacaine in reducing the incidence and severity of ED. Materials and Methods: Seventy-five children of either sex underwent lower abdominal or perineal surgeries. Patients were divided into three equal groups; BD (received caudal bupivacaine dexmedetomidine), BM (received caudal bupivacaine midazolam), and B(received caudal bupivacaine only). All patients were monitored intra and post-operatively regarding their hemodynamics. The post-operative pediatric anesthesia emergence delirium scale (PAED) and the post-operative face, legs, activity, cry, and controllability (FLACC) pain scale was used to assess ED and pain. Results: Regarding the ED, group BD showed the least PAED score, followed by BM and then the B group, with the statistically significant difference found at 0 and 15 min in PACU (P