The effect of deep extubation on the emergence agitation in pediatric patients undergoing obstructive sleep apnea syndrome surgery: a randomized controlled study.

Emergence agitation (EA) is a common complication during recovery from pediatric anesthesia, particularly in children with obstructive sleep apnea syndrome (OSAS) undergoing tonsillectomy and adenoidectomy (T&A). This study aimed to compare the effects of dexmedetomidine-assisted deep extubation and awake extubation strategies on the incidence of EA in this high-risk population. In this prospective randomized trial, 100 children aged 3–10 years scheduled for T&A were allocated to either a dexmedetomidine-assisted deep extubation group (n = 50) or an awake extubation group (n = 50). The primary outcome was the incidence of EA, assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale with a diagnostic threshold > 10. Secondary outcomes included extubation time and post-anesthesia care unit (PACU) length of stay. The dexmedetomidine-assisted deep extubation group demonstrated a significantly lower incidence of EA compared to the awake extubation group (21.3% vs. 54%; p = 0.002; relative risk [95% confidence interval] = 0.394 [0.215–0.722]; NNT [number needed to treat] = 3.06). Extubation time was also significantly shorter in the deep extubation group (5.5 ± 2.02 vs. 11.7 ± 2.39 min; p < 0.001). No significant difference was observed in PACU length of stay between the two groups (60.4 ± 2.92 vs. 60.6 ± 3.14 min; p = 0.78). In this single-center randomized controlled trial, dexmedetomidine-assisted deep extubation was associated with a reduced incidence of EA and a shorter extubation time, without prolonging PACU stay or increasing observed adverse events.Trial registration: Chictr.org.cn; Identifier: ChiCTR2300075947; registered 20 September 2023.