Abstract: ObjectiveTo investigate the efficacy of premedication with oral transmucosal buccal dexmedetomidine
(DEX) on the incidence of emergence agitation in children undergoing tonsillectomy under sevoflurane anesthesia.
MethodsA total of 90 children who were scheduled for tonsillectomy under general anesthesia were randomly divided into
three groups: DEX-Ⅰ group, DEX-Ⅱ group and control group, with 30 patients in each group. The DEX-Ⅰ group and the
DEX- Ⅱ group were given dexmedetomidine 1 μg/kg and 2 μg/kg via buccal mucosa at 30 minutes before surgery,
respectively. The control group was given normal saline in the same manner at the same time point. Preoperative sedation
score, intraoperative mean arterial pressure (MAP), heart rate (HR) and oxygen saturation, extubating time, Watcha’s
agitation scale at 5 min, 10 min, 15 min, 30 min, 45 min and 60 min after admission to post anesthesia care unit (PACU),
modified OPS pain score at the same time point and occurrence of perioperative adverse events were recorded. Postoperative
agitation was considered when Watcha’s agitation score was ≥3. ResultsThere were no significant differences in
demographics, preoperative sedation score, duration of operation and extubating time between the 3 groups. The Watcha’s
agitation scores at the four time points of 5, 10, 15 and 60 min after entering PACU were lower in DEX-Ⅰ and DEX-Ⅱ
groups than those of the control group. There were no significant differences in the four time point scores between DEX-Ⅰ
group and DEX-Ⅱ group. The modified OPS pain scores at the four time points of 5, 10, 15 and 30 min after entering PACU
were lower in DEX-Ⅰ and DEX-Ⅱ groups than those of control group. There were no significant differences in the four time
point scores between the two DEX groups. Compared with the control group, the HR and MAP were significantly lower in
DEX groups, but within the normal clinical range. No adverse events were observed during perioperative period in all three
groups. ConclusionPreoperative administration of dexmedetomidine 1-2 μg/kg via the buccal mucosa can effectively
reduce the incidence of postoperative agitation in children with general anesthesia.

Key words: dexmedetomidine, anesthesia, general, emergence agitation, buccal mucosa, child