Premedication with dexmedetomidine to reduce emergence agitation: a randomized controlled trial

BACKGROUND: Nasal bone fracture is the most common type of facial fracture, and the high incidence of severe emergence agitation occurring after closed reduction of the nasal bone fracture can be challenging to manage. The purpose of this trial was to evaluate whether pre-operative administration of dexmedetomidine is effective in reducing the incidence and severity of emergence agitation in adults undergoing closed reduction of nasal bone fractures. METHODS: In this randomized controlled trial, 90 patients who were scheduled to undergo closed reduction of a nasal bone fracture were prospectively included and were randomly assigned to either the control group (n = 45; 0.9% saline infusion) or the dexmedetomidine group (n = 45; 1 μ/kg over 10 min, pre-operatively). The primary endpoint was Aono’s four-point scale scores after anesthesia. The recovery time and numeric rating scale score were assessed as secondary endpoints. RESULTS: Aono’s four-point scale scores were lower in the dexmedetomidine group than in the control group (median: 1 [1] vs. 1 [1, 2], 95% confidence interval of difference: 0.01 to 0.02, P = 0.02). The number, severity, and duration of agitation episodes were significantly lower in the dexmedetomidine group than in the control group. Furthermore, the number of patients exhibiting intraoperative movement was lower in the dexmedetomidine group. CONCLUSIONS: Pre-operative administration of dexmedetomidine demonstrated several significant benefits, such as a lower incidence of emergence agitation, reduced agitation severity, and a shorter duration of agitation. Additionally, we observed more stable maintenance of intraoperative anesthesia with less movement during the surgery. TRIAL REGISTRATION: Identifier: KCT0000585 (registration date: 12–19- 2012).