Evaluating the Effects of Intraoperative Intravenous Dexmedetomidine Administration During Pediatric Ambulatory Adenotonsillectomy and Dental Surgical Procedures
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Dexmedetomidine, a α2-adrenergic agonist drug, is used during pediatric surgical procedures to create a balanced anesthetic and to decrease the amount of opioid and volatile anesthetic required, as well as incidence of emergence delirium (ED). The purpose of this Doctor of Nursing Practice (DNP) project was to examine the effects of intraoperative intravenous (IV) dexmedetomidine on narcotic requirements, pain scores, incidence of postoperative nausea and vomiting (PONV), and post-anesthesia recovery unit (PACU) length of stay among pediatric adenotonsillectomy (T&A) and dental surgical patients aged two to eight years old in a Western New York children’s hospital. A retrospective chart review was conducted over 3-months. Kurt Lewin’s Theory of Planned Change was the theoretical framework. Data collected included intraoperative morphine administration, PACU pain scores, Pro Re Nata (PRN) (as needed) opioid administration in recovery, PACU duration, PONV incidence, and total perioperative morphine administration. For the total sample and for dental surgical procedures, intraoperative dexmedetomidine use resulted in a statistically significant decreased average weight-based total intraoperative and perioperative narcotic administration. Although an increased duration of PACU stay of five minutes was also found as statistically significant with intraoperative dexmedetomidine use, the prolonged stay was not considered detrimental to work flow in the ambulatory setting. Among pediatric patients, dexmedetomidine may decrease narcotic requirements during dental surgical procedures but may not be as beneficial in procedures deemed to be more painful or stimulating. Results were presented via an educational inservice at the project site to anesthesia providers, mentors, and hospital stakeholders.