Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery

Background/Purpose/Question.  Emergence delirium (ED) is an acute phenomenon that develops in the early phase of recovery from general anesthesia, and characterized by confusion, disorientation, & possible violent behavior, and is a common occurrence particularly with nasal surgery. Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that results in anxiolysis, sedation, analgesia, and sympatholysis without depressing ventilation. This educational scholarly project aimed to review the literature and investigate the effect of intraoperative dexmedetomidine on the incidence of ED in adults recovering from general anesthesia after nasal surgery. Methods/Evidence Search.  PubMed and EMBASE were structurally searched from 2011 to 2021. Five randomized controlled studies (RCT) were selected that compared intraoperative dexmedetomidine to a placebo and how the recovery profile was affected in adults after nasal surgery. Key search terms included “anesthesia”, “dexmedetomidine”, “emergence”, “nasal surgery”. Synthesis of Literature/Results/Discussion.  There were collectively 392 participants across these five studies, and the incidence of ED in dexmedetomidine groups was significantly lower than control groups (respectively 21% vs. 50%). The mean arterial pressure (MAP) and heart rate (HR) among dexmedetomidine groups exhibited less variability during emergence without hypotension, which indicates a more stable hemodynamic profile. Analgesic and antiemetic requirements in the post-anesthesia care unit (PACU) were decreased in dexmedetomidine groups, however these results were not statistically significant. Conclusion/Recommendations for Practice.  Intraoperative dexmedetomidine significantly decreases the incidence of ED. Secondary effects, like hemodynamic stability and analgesia, were observed, but these qualities need to be further studied before they can be generalized. Overall, dexmedetomidine is a safe and effective anesthetic adjunct that facilitates a smoother emergence after nasal surgery without any complications. Keywords: Anesthesia, dexmedetomidine, emergence, nasal surger