Pain fentanyl consumption and delirium in adolescents after scoliosis surgery dexmedetomidine vs midazolam

Abstract

Background: The study aim was to compare the efficacy of dexmedetomidinevs midazolam for sedation during the early postoperative period in adoles-cents who underwent scoliosis surgery.Methods: We performed a prospective, randomized trial in an intensive careunit (ICU) in a tertiary care center. In this study, 42 patients (American Soci-ety of Anesthesiology physical status I and II) who underwent scoliosissurgery were divided into two groups according to sedation protocols: groupdexmedetomidine (DEX) (n = 22) and group midazolam (MDZ) (n = 20).Adolescents (12–18 years) requiring mechanical ventilation underwent a con-tinuous infusion of either dexmedetomidine (group DEX; starting dose,0.4 lgkg1h1) or midazolam (group MDZ; starting dose, 0.1 mgkg1h1)with intermittent fentanyl, as needed. The efficacy of sedation was assessedusing the Richmond Agitation Sedation Scale (RASS). Quality of pain reliefwas measured using the Numeric Visual Analog Scale (NVAS). Delirium wasdetermined in patients in the RASS range of 2to+1 using the ConfusionAssessment Method for the ICU (CAM-ICU). Fentanyl consumption,incidence of delirium, NVAS scores, and hemodynamics were recordedpostoperatively at 2, 4, 6, and 24 h in the ICU.Results: The NVAS pain scores and fentanyl consumption at all the evalua-tion time points were significantly higher in group MDZ than those in groupDEX (P < 0.05). Further, total fentanyl consumption in group MDZ was sig-nificantly higher than that in group DEX (P < 0.05). Delirium was signifi-cantly higher in the group MDZ than that in group DEX (31.3% vs 12.5%)when analyzed as the endpoint of CAM-ICU (P < 0.05). The heart rate wassignificantly lower in group DEX compared with that in group MDZ at allthe evaluation time points (P < 0.05).Conclusion: Dexmedetomidine was associated with the decreased postopera-tive fentanyl consumption, NVAS scores, and a decreased incidence of delir-ium. These findings may be beneficial for managing sedation protocols inadolescents who have undergone scoliosis surgery.