The effect of dexmedetomidine during myringotomy and pressure‐equalizing tube placement in children

Summary Background: Bilateral myringotomy (BMT) is a commonly performed otolaryngologic procedure in children. Objectives: To examine the effects of intranasal dexmedetomidine, an α 2 ‐adrenoceptor agonist, on time‐averaged pain scores, pain control, need for rescue analgesia, and agitation scores in children undergoing BMT. Methods: We designed a trial to enroll 160 children randomized to one of four groups: two study groups, dexmedetomidine (1 or 2 μg·kg −1 ), or two control groups representing our institutional standards of practice (intranasal fentanyl‐2 μg·kg −1 or acetaminophen as needed postoperatively). Results: After 101 children were enrolled, patient caregivers observed that some enrollees were excessively sedated and required prolonged postanesthesia care unit (PACU) stay. This observation led to an unplanned interim analysis and early trial termination. After data were collected, severe nonnormality of pain and agitation scores necessitated a switch of the outcome to assess repeated measurements of the proportion of patients with pain, severe pain, and agitation. Demographics, time to emergence, and agitation were similar among all groups. The risk of requiring acetaminophen rescue ( P < 0.0001) and proportion of patients having pain ( P = 0.016) was significantly higher in one control group (rescue analgesia only) compared with fentanyl or dexmedetomidine groups. Importantly, length of stay in the PACU was significantly longer in dexmedetomidine‐2 μg·kg −1 ‐treated compared with dexmedetomidine‐1 μg·kg −1 ‐treated, fentanyl‐treated, or the control group, P = 0.0037. Conclusions: In this trial, we were unable to answer the original question as to the role of dexmedetomidine on time‐averaged pain and agitation scores after BMT. However, our findings clearly demonstrate that in children undergoing BMT, at higher doses, dexmedetomidine significantly prolongs length of stay in the PACU.