P55
THE ROLE OF DEXMEDETOMIDINE IN ANAESTHESIA FOR CLEFT PALATE SURGERY AT A SINGLE TERTIARY CENTRE
L. Bubb, R. Goel, K. Gillespie, J. Keough
Alder Hey Children's NHS Foundation Trust, UK
Introduction/Aim
Alder Hey provides cleft surgery to paediatric patients as part of the Northwest, Isle of Man and North Wales Cleft Lip and Palate Network.
Dexmedetomidine has several properties that should be beneficial to patients undergoing cleft surgery. When given as a single bolus dose, it has analgesic and decongestant effects, reduces the incidence of emergence delirium and prolongs the duration of regional anaesthesia1,2. There is also evidence that it reduces coughing on emergence from anaesthesia3.
Dexmedetomidine use is increasing within our centre, however its use within paediatric anaesthetic practice remains off-label2. As part of a wider evaluation of anaesthesia for cleft procedures at Alder Hey we wanted to assess the role of dexmedetomidine in the perioperative care of children undergoing cleft palate surgery.
Method
We retrospectively audited the electronic records of 112 children undergoing cleft surgery at Alder Hey in 2023. Data on anaesthetic technique including dexmedetomidine use and a range of outcome measures, including the time to first oral intake (FOI), length of hospital stay and post-operative morphine requirements was collected.
Results
31 cases received dexmedetomidine as part of their intraoperative anaesthetic management and 81 did not. Statistical significance was assessed using a two-tailed t-test. All dexmedetomidine was given as a single dose (mean: 0.99 mcg/kg), with the majority (27/31) of dexmedetomidine cases receiving a TIVA-based anaesthetic.
Discussion/Conclusion
Our results suggest a statistically significant association between dexmedetomidine use and earlier FOI post-operatively in patients undergoing cleft procedures, though we acknowledge that the majority of dexmedetomidine cases received a TIVA-based anaesthetic and we do not have sufficient data to determine the part which dexmedetomidine played. Dexmedetomidine cases also had statistically significant higher post-operative morphine requirements.
Cleft surgeries encompass a range of procedures, performed on a heterogenous group of patients. This introduces multiple confounders. For many procedures, there were insufficient numbers receiving dexmedetomidine to enable subgroup analysis. However, it was possible to examine those having either cleft lip with anterior cleft palate surgery or cleft palate surgery further, with similar numbers in the dexmedetomidine and dexmedetomidine-free arms.
In this subgroup, our results suggest a reduction in time to FOI of one hour – whilst this was not statistically significant it may be a clinically important finding that might be demonstrated fully in a larger sample population. Dexmedetomidine cases received lower doses of morphine intraoperatively and the post-operative morphine requirements were similar between the two groups.
Our results suggest dexmedetomidine could be a useful adjunct for patients undergoing cleft procedures, facilitating earlier oral intake post-operatively, but there may be associated increases in post-operative analgesic requirements. We recommend further study with increased sample sizes to ascertain whether its use may be beneficial for cleft palate surgery, both in TIVA and volatile-based anaesthetics.
References:
- Scott-Warren VL, Sebastian J. Dexmedetomidine: its use in intensive care medicine and anaesthesia. BJA Educ. 2016; 16: 242-246.
- Lin R, Ansermino JM. Dexmedetomidine in paediatric anaesthesia. BJA Educ. 2020; 20: 384-353.
- Tung A, Fergusson NA, Ng N et al. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis. Br J Anaesth. 2020; 124: 480-495.