Opioid-sparing anesthesia with pre-induction dexmetedomidine in children undergoing strabismus surgery: a prospective comparative cohort study
- 1Department of Ophthalmology, Azerbaijan Medical University, Baku, Azerbaijan
Abstract
Introduction Pediatric strabismus surgery is associated with the oculocardiac reflex (OCR), postoperative nausea and vomiting (PONV), emergence agitation (EA), and postoperative pain. Dexmedetomidine may facilitate an opioid-sparing anesthetic strategy and improve early postoperative recovery. This study evaluated perioperative outcomes associated with a low-dose pre-induction dexmedetomidine- containing regimen in children undergoing strabismus surgery. Materials and Methods This prospective comparative cohort study included 167 children aged 2–16 years undergoing elective strabismus surgery at Azerbaijan Medical University between 2022 and 2026. The control group (n=117) received propofol, sevoflurane, and fentanyl 5 μg/kg. The dexmedetomidine group (n=50) received intravenous dexmedetomidine 0.3 μg/kg before induction, together with propofol, sevoflurane, and fentanyl 3 μg/kg. OCR was defined as a ≥20% decrease in heart rate from the pre-manipulation baseline during extraocular muscle traction. PONV, EA, and rescue postoperative analgesia were prospectively recorded. Results OCR occurred in 75/117 patients (64.1%) in the control group and 30/50 (60.0%) in the dexmedetomidine group (p=0.727). PONV was documented in 100/117 control patients (85.5%) and in 0/50 dexmedetomidine patients (p<0.001). EA was documented in 100/117 (85.5%) and 0/50 patients, respectively (p<0.001). Rescue postoperative analgesia was required in 100/117 control patients (85.5%) and in 0/50 dexmedetomidine patients (p<0.001). The dexmedetomidine-containing protocol used a 40% lower fentanyl dose (3 vs 5 μg/kg). Conclusion A regimen incorporating pre-induction dexmedetomidine 0.3 μg/kg and lower fentanyl exposure was associated with favorable early postoperative recovery in this cohort, whereas OCR incidence was similar between groups. Because dexmedetomidine administration and fentanyl reduction were components of the same non-randomized protocol, the independent contribution of each cannot be determined. Randomized studies using standardized recovery measures are warranted.
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BibTeX
@article{ismailov2026opioidsparing,
title = {{Opioid-sparing anesthesia with pre-induction dexmetedomidine in children undergoing strabismus surgery: a prospective comparative cohort study}},
author = {G. Ismailov},
journal = {Pediatric Anesthesia and Critical Care Journal (PACCJ)},
year = {2026},
month = oct,
doi = {10.14587/paccj.2026.26},
url = {https://doi.org/10.14587/paccj.2026.26},
note = {CC BY},
}
RIS
TY - JOUR
TI - Opioid-sparing anesthesia with pre-induction dexmetedomidine in children undergoing strabismus surgery: a prospective comparative cohort study
AU - G. Ismailov
PY - 2026
DA - 2026/10/26
JO - Pediatric Anesthesia and Critical Care Journal (PACCJ)
DO - 10.14587/paccj.2026.26
UR - https://doi.org/10.14587/paccj.2026.26
AB - Introduction Pediatric strabismus surgery is associated with the oculocardiac reflex (OCR), postoperative nausea and vomiting (PONV), emergence agitation (EA), and postoperative pain. Dexmedetomidine may facilitate an opioid-sparing anesthetic strategy and improve early postoperative recovery. This study evaluated perioperative outcomes associated with a low-dose pre-induction dexmedetomidine- containing regimen in children undergoing strabismus surgery. Materials and Methods This prospective comparative cohort study included 167 children aged 2–16 years undergoing elective strabismus surgery at Azerbaijan Medical University between 2022 and 2026. The control group (n=117) received propofol, sevoflurane, and fentanyl 5 μg/kg. The dexmedetomidine group (n=50) received intravenous dexmedetomidine 0.3 μg/kg before induction, together with propofol, sevoflurane, and fentanyl 3 μg/kg. OCR was defined as a ≥20% decrease in heart rate from the pre-manipulation baseline during extraocular muscle traction. PONV, EA, and rescue postoperative analgesia were prospectively recorded. Results OCR occurred in 75/117 patients (64.1%) in the control group and 30/50 (60.0%) in the dexmedetomidine group (p=0.727). PONV was documented in 100/117 control patients (85.5%) and in 0/50 dexmedetomidine patients (p<0.001). EA was documented in 100/117 (85.5%) and 0/50 patients, respectively (p<0.001). Rescue postoperative analgesia was required in 100/117 control patients (85.5%) and in 0/50 dexmedetomidine patients (p<0.001). The dexmedetomidine-containing protocol used a 40% lower fentanyl dose (3 vs 5 μg/kg). Conclusion A regimen incorporating pre-induction dexmedetomidine 0.3 μg/kg and lower fentanyl exposure was associated with favorable early postoperative recovery in this cohort, whereas OCR incidence was similar between groups. Because dexmedetomidine administration and fentanyl reduction were components of the same non-randomized protocol, the independent contribution of each cannot be determined. Randomized studies using standardized recovery measures are warranted.
SN - 2281-8421
ER -