Pre - operative anxiety and emergence agitation are common issues among pediatric patients, which have various influences on the recovery progress and prognosis of children. Nasal administration of dexmedetomidine is a convenient and non - invasive sedation technique for children. This technique can reduce the incidences of pre - operative anxiety and emergence agitation. However, there are few studies on the effect of dexmedetomidine on intraoperative electroencephalographic activities.
In view of this, the investigators elaborately designed a prospective, multi - center, large - sample - sized, double - blind, randomized - controlled clinical trial. This trial aims to provide a basis for drug selection in pediatric anesthesia, ensuring the safety and comfort of pediatric anesthesia.
The investigators plan to select 627 participants who will undergo minor surgeries under general anesthesia. Thirty minutes before the surgery, dexmedetomidine or normal saline will be administered nasally to these participants. Before the surgery, the anxiety degree and sedation score of the participants will be assessed; during the surgery, the cooperation degree of patients during anesthesia induction will be evaluated and electroencephalographic monitoring will be carried out; after the surgery, the incidence of emergence agitation, the recovery time and the analgesic score of the participants will be assessed. Throughout the whole process, the occurrence of adverse reactions of participants will be fully monitored, and the adverse reactions will be timely recorded and treated.
2≤ age ≤6 years old, gender is not limited;
ASA anesthesia grade I ~ II; ③ For children who intend to undergo minor surgery under general anesthesia (including but not limited to minor surgery such as ENT surgery and hernia surgery), the operation duration is expected to be no more than 2 hours; ④ Family members agree to participate in the study and voluntarily sign informed consent;
Respiratory tract infection occurs within 4 weeks before surgery;
Potential or other contraindications to general anesthesia;
There are nasal diseases, nasal bleeding, sinusitis, nasal polyps and other conditions that affect nasal absorption; ④ Heart, liver, kidney and other vital organ dysfunction or blood system diseases;
Allergy or intolerance to dexmedetomidine or other α2-adrenergic receptor agonists;
Parallel
Preoperative sedation with dexmedetomidine was administered nasal before surgery
DrugDo not drink or fast before operation. Before entering the operating room, 2 sprits of dexmedetomidine were administered intranasally (1-2ug/kg) with conventional open venous access
Preoperative sedation with normal saline was administered nasal before surgery
DrugDo not drink or fast before operation. Before entering the operating room, 2 sprits of normal saline were administered intranasally (equal volume) with conventional open venous access
Success rate of preoperative sedation
Successful sedation was considered when participants received Ramsay sedation score ≥3 on the sedation scale 30 minutes after medication.
Incidence of emergence agitation
Immediately after extubation, the Pediatric Anesthesia Emergence Delirium (PAED) Scale and the 5-Point Agitation Scale for Emergence Agitation were used to assess the level of postoperative emergence agitation (EA) in the participants. Subsequent assessments were conducted every 15 minutes until the participants was transferred back to the ward. A PAED score ≥ 12 or a 5-Point Agitation Scale score \> 3 could be diagnosed as emergence agitation.
Intraoperative brain electrical activity differences
The characteristics of four kinds of brain wave α, β ,δ and θ were analyzed by professional EEG analysis software
Preoperative anxiety
The modified Yale Preoperative Anxiety Scale (mYPAS) was used to quantify the anxiety level of children before and 15min and 30min after administration, respectively. There are 22 items in the scale, including activity, language, emotional expression, arousal state and dependence on parents, etc. According to the difference of each item, children's behavior is divided into grades 1\~4 or 1\~6, and the total score after conversion is 23.33\~100 points (conversion formula: The actual score of each part = (score ÷ number of items in each part) × (100÷ number of parts)), the higher the total score, the higher the anxiety level of the child.
Degree of cooperation in anesthesia induction
The Induction Compliance Checklist (ICC) was used to assess the child's cooperation during the anesthesia induction period after entering the operating room and before the induction of anesthesia. The checklist includes 10 negative behaviors, totaling 11 items, covering all possible reactions of the child during anesthesia induction. A score of 0 is recorded if the child exhibits no negative behaviors during induction, while a score of 1 is recorded for each negative behavior observed. The scores for each item are summed, with a maximum score of 10. A lower ICC score indicates better cooperation during the induction period. A score of 0 indicates full cooperation, 1-3 indicates moderate cooperation, and a score ≥ 4 indicates non-cooperation.
Postoperative recovery time
The period from the cessation of anesthetic administration until the patient regains consciousness and can respond appropriately to external stimuli.
Incidence of delayed recovery
Participants fail to open their eyes, shake hands, or show any significant response to painful stimuli for more than 30 minutes after surgery.
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Fuzhou Hua
Lead sponsor
Second Affiliated Hospital of Nanchang University
Sponsor institution
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