| Background and ObjectiveWith the improvement of life level,the prevalence of primary teeth in children have increased,appearing such as dental caries, pulpits, periodontal infection etc.These children can be treated in outpatient department for dental repair, extractions and other operations.It is also be used to some oral trauma, especially trauma caused by defects in the teeth.However, due to higher incidence of non-cooperation in the children,these surgical operation may lead to broken instruments, palate and soft tissue damage, or even aspiration if swallowed.If children were bound to treated may cause severe psychological damage.Such children are more suitable for outpatient dental treatment under general anesthesia.Outpatient general anesthesia is more humane, and it has more advantages for uncooperative children: avoiding reducing hospitalizations in children, reducing medical resource consumption; reducing the treatment period in children, helping children recover.And not causing bring severe psychological trauma to children.But at the same time some problems coming with general anesthesia: fear or reject vein needle puncture, difficulties in children separated from their parents, uncooperative mask induction. It is still a difficulty for many anesthetists how to keep a child undergoing general anesthesia good sedition and safety before operation.Therefore, the appropriate choice of preoperative sedation medicine is necessary.Preoperative sedation medicine play a good sedative effect, making children in sleeping, avoiding the psychological damage in children. The preparation of general anesthesia before surgery is also benefit from that.Dexmedetomidine is a highly selective α2 adrenoceptor agonist, it acts as sedation, sympatholysis, sympatholytic, anxiolysis, stable hemodynamic.What is more,it has little effects on respiratory and haemodynamics. Intranasal and oral administration of dexmedetomidine are relatively easy ways of medication for children.These ways are easier to tolerate,and there will be not unpleasant experience or irritation for children.However, application of the two ways for outpatient anesthesia has not been reported.This study aimed to explore the efficacy and safety of its sedation with oral and intranasal administration in children for pediatric dentistry under general anesthesia, providing a theoretical basis for clinical applications. Methods75 pediatric patients,exclusion criteria included allergy or hypersensitivity to dexmedetomidine, organ dysfunction, cardiac arrhythmia,congenital heart disease or mental retardation,ASA I-II, aged 3-6 years,were randomly assigned to five groups to receive dexmedetomidine or placebo: 1.0 μg/kg dexmedetomidine intranasally(group DN1), 2.0μg/kg dexmedetomidine intranasally(group DN2),2.0μg/kg dexmedetomidine orally(group DO2), 4.0μg/kg dexmedetomidine orally(group DO4), 5ml 50% glucose injection orally(group C).The study drμg was prepared in a 1 ml syringe by an anaesthetist not involved in administering anaesthesia to the children. Dexmedetomidine was diluted with the same volume 0.9% saline for group DN1. The final volume was equivalent to 0.02 ml·kg-1, an equal volume was dripped into each nostril.Dexmedetomidine was diluted to 5ml with 10% glucose injection for group DO2 and group DO4.All recruited patients were sent to the pre-operative room accompanied by parents.. After the first recording of blood pressure, oxygen saturation and heart rate, dexmedetomidine or placebo was administered by a trained research assistant.At the same time this trained anesthetist assessed acceptance of administration of dexmedetomidine to children.We defined the level of acceptance of administration of dexmedetomidine to children:Good: obeying instructions, no resistance; General: resistance, but can be convinced; Poor: resistance, crying.Use Funk sedation score table every 15 min assessed sedation in children. 30 min after administration specialized nurses did vein puncture, after successfully puncture children would be transmited to the treatment room.Used Funk sedation score table to assess the state of vein puncture of children and separated with their parents. Mask induction with sevoflurane and oxygen. Used Funk sedation score table to assess the acceptance of mask induction.After children sleeping, intravenous administration: atropine 0.01mg/kg, dexamethasone 0.1mg/kg, cis-atracurium 0.15mg/kg, fentanyl 4μg/kg. Maintain anesthesia with sevoflurane. After surgery we executed suctioning, and we extubated the tube until children get awake or up to the extubation conditions.Then we observed the patient for 5min before they were sent to post-anesthesia care unit(PACU).In PACU children were observed for 1hour at least,they got home from PACU until Steward score ≥ 4.Postoperative follow-up using telephone within 24 hous, we needed to ask the relevant discomfort events. Record some adverse reactions happened to children within 24 hous after surgery,such as postoperative pain, the situation nausea, vomiting, lethargy, syncope and so on. Results1.Baseline characteristics were similar for all patients between groups in age, sex, weight, operation time, ASA classification(P> 0.05)2.Sedative score of each group: levels of preoperative sedation of group DN1,DN2,DO2, DO4 were significantly higher than group C(P<0.05). Level of preoperative sedation of group DN2 was significantly higher than group DN1 and group DO2(P<0.05), similar with group DO4(P>0.05), especially the level of sedation of intravenous cannulation and separation from parents(P<0.01).And there was no significant difference between level of preoperative sedation of group DN1 and group DO2(P>0.05).3.Hemodynamic changes:there were some changes in heart rate,blood pressure and oxygen saturation of each group, but there was no significant difference among five groups.4.Others: acceptances of administration of each group were different: Children with poor acceptance for intranasal administration, while relatively good for oral administration(P<0.05). The number of children with sleep was most in Group DN2. And the number of children with sleep of group DN1, group DN2,group DO2,group DO4, Group C were 7 cases, 8 cases, 13 cases, 11 cases, 2 cases. There was a statistically significant difference among them(P<0.05). Follow-up within 24 hous after surgery: the number of children with nausea and vomiting of group DN1,group DN2,group DO2,group DO4, group C were 0 case, 1case, 1 case, 1 case, 0 case. The number of children with lethargy of group DO4 was 1case.Other adverse reactions did not occur. Conclusions1.1μg/kg and can play a good sedative effect, and the sedative effect of 2μg/kg dexmedetomidine administered intranasally is better.2.2μg/kg and 4μg/kg of dexmedetomidine administered orally can play a good sedative effect,and the sedative effect of 2μg/kg dexmedetomidine administered orally is better.3.The sedative effect of 2μg/kg of dexmedetomidine administered intranasally is similar to 4μg/kg of dexmedetomidine administered orally,but oral administration is more acceptable for children. |
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