Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study.

PURPOSE: Emergence agitation (EA) after (adeno)tonsillectomy (AT) surgery impairs recovery in children. Adequate analgesia plays a crucial role in reducing EA incidence. This study investigated whether hydromorphone infusion (30 μg/kg) during anesthesia induction could reduce EA following AT surgery for obstructive sleep apnea in children.

PATIENTS AND

METHODS

A total of 186 ASA I-III children aged 3-7 years undergoing AT surgery were enrolled in a blinded randomized trial comparing hydromorphone (30 μg/kg) to fentanyl (4 μg/kg). The primary outcome was EA incidence within 30 min post-extubation. Secondary outcomes included pediatric anesthesia emergence delirium (PAED), face, legs, activity, crying, consolability (FLACC), Ramsay sedation scores, extubation time, rescue analgesia incidence, and adverse events.

RESULTS

The incidence of EA was significantly lower in the hydromorphone group [48.4% (45/93) vs 64.5% (60/93); absolute difference: 16.1%; 95% CI: 18.9-29.5%; P = 0.027]. Hydromorphone improved PAED, FLACC, and Ramsay scores and reduced moderate-to-severe pain and rescue analgesia. No postoperative complications occurred in either group.

CONCLUSION

Hydromorphone at 30 μg/kg effectively reduces the incidence of EA within 30 min post-extubation in children after AT surgery compared to fentanyl. It shows superior analgesia and has a low incidence of adverse effects.