Background: Dexmedetomidine has been extensively studied in recent years for its anxiolysis, sympatholysis, analgesia and anesthetic-sparing effect with minimal respiratory depression. Given these properties, and despite lack of FDA approval for pediatric use, its role in the pediatric perioperative setting has expanded steadily. Rotaplast International provides free cleft lip and palate repair in less-developed countries around the world as well as education and training for comprehensive treatment of these children. A large pediatric population is served in Guatemala, and dexmedetomidine has seen increased use intraoperatively to aid in postoperative recovery. This study examines whether dexmedetomidine has a significant impact on emergence and PACU times as well as total opioid consumption.
Methods: The study design was reviewed with our local IRB and constructed for collection of de-identified data that did not require informed patient consent. Medical records from Rotaplast missions in 2016 to Retalhuleu, Guatemala; Chittagong, Bangladesh; Lima, Peru; and Pereira, Colombia were retrospectively reviewed to identify cleft lip, cleft lip revision, cleft palate and cleft palate revision cases. 61 cases were identified, 44 in the Guatemala trip, all whom were administered dexmedetomidine intraoperatively and 17 cases from the other 3 trips where dexmedetomidine was not used. From these charts information was collected regarding age, weight, surgery length, time to emergence, episodes of severe hemodynamic changes(hypo-/hypertension and brady-/tachycardia), PACU length of stay, and perioperative complications as well as total dosage of fentanyl, morphine, and tylenol.
Results: Data available at this time from the 2016 Retalhuleu, Guatemala trip was compared to 3 other trips in 2016 with patients not receiving any dexmedetomidine. The 44 patients in Retalhuleu, Guatemala of which 12 were cleft lips, 10 lip revisions, 21 cleft palates and 1 palate revision were compared to 8 cleft lips, 2 lip revisions, 3 cleft palates and 4 palate revisions. For the Guatemala trip (mean +/- stdev): age 68 +/- 56.4 months, weight 18 +/- 12.7 kg, dex 0.6 +/- 0.4 mcg/kg, intraoperative fentanyl 2.5 +/- 2.2 mcg/kg, emergence time 7 +/-5.7 mins, and PACU length of stay 63 +/- 30.2 min. With the 3 other missions: age 36 +/- 38.8 months, weight 13 +/- 9.7 kg, intraoperative fentanyl 2.2 +/- 1.9 mcg/kg, intraoperative morphine 0.1+/- 0.1 mg/kg, emergence time 10 +/- 9 min, PACU length of stay 59 +/- 29.3 min.
Conclusions: To date there has been no retrospective study based on intraoperative anesthetic records from the Rotaplast mission trips. This study, as a proof of concept, shows that even though anesthesia is being performed under challenging conditions in a resource limited environment, quality data has been preserved in these records. However our current study is extremely limited at this time and it would be beneficial to review a greater volume of intraoperative records prior to performing a more robust analysis on the effects of dexmedetomidine on measured outcomes such as emergence time, PACU duration and use of perioperative opiates.
