Dexmedetomidine vs. midazolam at single low doses for opioid and muscle relaxant-free anesthesia in pediatric dentistry: a randomized control trial.

OBJECTIVES: To verify whether a single low dose of dexmedetomidine could reduce emergence agitation (EA) among pediatric dental patients undergoing outpatient general anesthesia in a clinical dental setting. STUDY DESIGN: Prospective randomized clinical trial. METHODS: This study included 90 children scheduled for elective dental procedures. Patients were randomly assigned to three groups: midazolam (MID, 0.02 mg/kg, n = 30), dexmedetomidine (DEX, 0.2 μg/kg, n = 30), and normal saline (NS, n = 30). The primary endpoint was EA, with time to extubation (TOE), time to wake-up (TOW), hemodynamic fluctuations and anesthesia-related complications considered as the secondary outcome. RESULTS: The incidence of EA in the DEX group was significantly lower than that in the saline group, while the incidence in the Mid group showed no significant difference compared with the other two groups after a Bonferroni correction. The three groups showed statistically significant differences in TOW recovery time, with the DEX group having the longest, the Mid group intermediate, and the saline group the shortest. CONCLUSION: A single low dose of dexmedetomidine at induction significantly reduces EA in pediatric dental outpatients, without compromising day-surgery discharge feasibility despite a modest prolongation of recovery time. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=215673.