Impact of Caudal Dexmedetomidine Versus Midazolam on Preventing Emergence Delirium after Sevoflurane Anesthesia in Pediatric Patients: A Prospective Randomized Trial

Background: Postoperative emergence delirium (ED) is common in pediatric patients anesthetized with sevoflurane. ED carries many complications, such as disorientation and perceptual changes, including motor hyperactivity and hypersensitivity to stimuli. ED usually appears in the early 30 min after awakening from general anesthesia. We assessed the effect of caudal dexmedetomidine versus midazolam added to bupivacaine in reducing the incidence and severity of ED. Materials and Methods: Seventy-five children of either sex underwent lower abdominal or perineal surgeries. Patients were divided into three equal groups; BD (received caudal bupivacaine dexmedetomidine), BM (received caudal bupivacaine midazolam), and B(received caudal bupivacaine only). All patients were monitored intra and post-operatively regarding their hemodynamics. The post-operative pediatric anesthesia emergence delirium scale (PAED) and the post-operative face, legs, activity, cry, and controllability (FLACC) pain scale was used to assess ED and pain. Results: Regarding the ED, group BD showed the least PAED score, followed by BM and then the B group, with the statistically significant difference found at 0 and 15 min in PACU (P<0.05). Assessment of the FLACC score and time of emergence revealed no statistically significant difference. At the same time, the number of patients who received IV dexmedetomidine and PACU stay was significant in group B (P<0.05). The intra-operative hemodynamics (NIBP, HR) showed no statistically significant difference between the three groups. In contrast, post-operative systolic blood pressure and heart rate showed a statistically significant difference at 0 and 15 minutes with higher values in group B, BM then the lowest values were recorded in group BD (P<0.05). Regarding the peri-operative complications, no patients experienced hypotension or bradycardia in the three groups. Conclusion: Caudal dexmedetomidine and caudal midazolam are safe and efficient in decreasing the incidence and severity of ED. Furthermore, dexmedetomidine was more efficient, with the least PAED score. Dexmedetomidine is recommended to be used as an adjuvant to bupivacaine in the pediatric caudal block.