Dexmedetomidine and Remifentanil for Lithotripsy at the Pediatric Age: A Prospective Randomized Double-blind Study - Abstract
Background: Non-invasive but painful ambulatory urolithiasis treatment, extracorporeal shock wave lithotripsy [ESWL], necessitates immobilization in pediatric age. Appropriate anesthetic agent is crucial for convenient sedoanalgesia, remifentanil generally being used for this purpose. Although dexmedetomidine still not approved by FDA for any pediatric indication, increasing experience with its use in many pediatric scenarios led us to test for ESWL in pediatric patients. So, we compared the hemodynamic, sedative, analgesic and side effects with recovery profiles of dexmedetomidine and remifentanil for ESWL at the pediatric age.
Methods: In this prospective, double-blind study, seventy children under going elective ESWL were randomly assigned to a dexmedetomidine [Group D, n=35] or a remifentanil group [Group R, n=35].
Results: The procedure was well tolerated in both groups. Heart rate [HR] reduction at 10th and 20th minutes for group R [p<0.05], and at every measurement for group D [p<0.001] with significant low SpO2 values for group R compared to group D at 15 and 20 minutes [p<0.05] were observed. Ramsay scores increased within the individual groups [p=0.001], being higher in group R [p=0.024]. Pain scores were decreased compared to baseline in both groups [p<0.001]; being higher in group R at 5, 10 and 15 minutes [p=0.0001]. Respiratory depression and apnea observed in 20% of patients receiving remifentanil [p=0.011].
Conclusion: Both groups provided similar sedoanalgesic effects, yet dexmedetomidine offers comfortable and secure anesthesia with little systemic side-effects along with less respiratory problems suggesting relevance for conscious anesthesia during ESWL at the pediatric age.