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Dexmedetomidine for Improved Quality of Emergence From General Anesthesia: A Dose-Finding Study

Aouad, Marie T. MD*; Zeeni, Carine MD*; Al Nawwar, Rony MD*; Siddik-Sayyid, Sahar M. MD, MHPE*; Barakat, Hanane B. MD; Elias, Sandra MD*; Yazbeck Karam, Vanda G. MD, MHPE

doi: 10.1213/ANE.0000000000002763
Anesthetic Clinical Pharmacology: Original Clinical Research Report

BACKGROUND: Dexmedetomidine provides smooth and hemodynamically stable emergence at the expense of hypotension, delayed recovery, and sedation. We investigated the optimal dose of dexmedetomidine for prevention of cough, agitation, hypertension, tachycardia, and shivering, with minimal side effects.

METHODS: In this prospective, randomized, double-blind trial, 216 adult patients were randomly assigned to dexmedetomidine 1 µg/kg (D 1), 0.5 µg/kg (D 0.5), 0.25 µg/kg (D 0.25), or control (C). During emergence, cough, agitation, hemodynamic parameters, shivering, time to extubation, and sedation scores were recorded.

RESULTS: A total of 190 patients were analyzed. The respective incidences for the groups D 1, D 0.5, and D 0.25 versus group C were 48%, 64%, and 64% vs 84% for cough—corrected P < .003 between groups D 1 and C; 33%, 34%, and 33% vs 72% for agitation—corrected P < .003 between group C and each of the study groups; and 4%, 2%, and 7% vs 22% for shivering—corrected P = .03 and corrected P = .009 between groups D 1 and D 0.5 versus group C, respectively. The percent increase from baseline blood pressure on extubation for the 3 treatment groups was significantly lower than group C. Percent increase in heart rate was lower than control in groups D 1 and D 0.5 but not in group D 0.25. Time to extubation and sedation scores were comparable. However, more hypotension was recorded during the emergence phase in the 3 treatment groups versus group C.

CONCLUSIONS: D 1 at the end of surgery provides the best quality of emergence from general anesthesia including the control of cough, agitation, hypertension, tachycardia, and shivering. D 0.5 also controls emergence phenomena but is less effective in controlling cough. The 3 doses do not delay extubation. However, they cause dose-dependent hypotension.

From the *Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon

Department of Anesthesiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.

Published ahead of print 29 December 2017.

Accepted for publication November 8, 2017.

Funding: None.

The authors declare no conflicts of interest.

Clinical trial number and registry: NCT02141412; URL:

Reprints will not be available from the authors.

Address correspondence to Vanda G. Yazbeck Karam, MD, MHPE, Lebanese American University Medical Center-Rizk Hospital, PO Box 113288, Zahar St, Beirut, Lebanon. Address e-mail to

Copyright © 2017 International Anesthesia Research Society
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