Background and Aims:Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children.Material and Methods:With randomization, Group O (30 children): Received oral midazolam syrup 0.5 mg/kg and Group IN (30 children): Received intranasal midazolam spray 0.2 mg/kg. Every child was observed for acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug. Data were analyzed using Student's t-test, standard error of the difference between two means and Chi-square test.Results:In Group O and IN, 15/30 children (50%) and 7/30 children (23%) accepted drug easily (P < 0.05); 4/22 children (18%) in Group O and 11/20 children (55%) in Group IN cried after drug administration (P < 0.05). In both the groups, sedation at 20 min after premedication (Group O [80%] 24/30 vs. Group IN [77%] 23/30), parental separation and acceptance to mask were comparable (P > 0.05); 12/30 children (40%) in Group IN showed transient nasal irritation.Conclusion:Oral midazolam and intranasal midazolam spray produce similar anxiolysis and sedation, but acceptance of drug and response to drug administration is better with oral route.

BACKGROUND: Preoperative anxiety and long-term behavioural problems are inevitable consequences in absence of preoperative sedation in paediatric patients undergoing surgery. An ideal premedicant removes fear and anxiety in tender minds of children and achieves a calm, sedated child for smooth induction of anaesthesia and rapid recovery in postoperative period. Midazolam is the most commonly used premedicant in children as it satisfies most of the criteria of ideal premedicant but its route of administration is a debatable issue in anaesthesia practice. AIMS: This study evaluated the efficacy of atomized intranasal midazolam spray as a painless, userfriendly, needleless system of drug administration for pre-anaesthetic medication in paediatric patients. SETTINGS AND DESIGN: Tertiary hospital, a prospective, randomized, controlled, clinical study. METHODS AND MATERIAL: 60 ASA physical status I children of 2-5 years age group, weighing 10-18 kg scheduled for routine surgeries participated in the study. Children were randomly assigned to Group M: Received intranasal midazolam spray in doses of 0.2 mg/kg and Group N: Received normal saline drops (1-2 drops/nostril). Patients were observed in preoperative room for 20 min. Acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug were noted. STATISTICAL ANALYSIS: Student 't' test, standard error of difference between two means and Chi-square test. p value<0.05 was considered as statistically significant. RESULTS AND CONCLUSION: 35% children in group M and 42.10% children in group N cried after drug administration who were not crying before drug administration (p>0.05). 20 min after premedication 76.66% in group M and 10.00% group N, children showed satisfactory sedation (p<0.05). 73.33% in group M while 26.66% in group N, children showed acceptable parental separation and 86.66% in group M while 23.33% group N, children showed satisfactory acceptance to mask (p<0.05). Transient nasal irritation in the form of rubbing of nose, watering, sneezing and lacrimation was observed in 40% children of group M. Intranasal midazolam by atomized spray is safe and effective premedicant in paediatric patients. It produces effective sedation and anxiolysis in children. Transient nasal irritation is an undesirable side effect observed with intranasal route.

Background: Subclavian perivascular block aims to anaesthetise three trunks of the brachial plexus at its most compact point. Hence, a low dose of local anaesthesia is sufficient. Methods: The prospective randomised study consisted of 60 adult patients belonging to American Society of Anaesthesiologists (ASA) classification Grade I and II, scheduled for upper-limb surgeries, who were randomised to Group A (US-guided supraclavicular block) and Group B (US-guided subclavian perivascular block). Blocks were performed with a 20 mL equal mixture of 2% lignocaine + adrenaline and 0.5% bupivacaine. Sensory and motor blockades were assessed using a needle prick method and four-point scale, respectively; blockade was evaluated every 3 min till onset and then every 30 min after surgery. Eventually, inference was made in terms of block performance time, onsets and duration of sensory and motor blocks and first rescue analgesia. Results: The mean age, body mass index, gender and ASA grades of the patients in both the groups were comparable. The block performance time was significantly shorter in Group B (12.3 ± 1.53) compared to Group A (21.90 ± 2.47; P < 0.0001). The complete blockade time for sensory and motor blocks was significantly shorter in Group B compared to Group A (P < 0.0001), whereas no significant difference was found with respect to first rescue analgesia (P = 0.9688). Conclusions: US-guided subclavian perivascular block is more rapidly executed than US-guided supraclavicular block with a similar duration of blockade.

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Popliteal block is a distal block of the sciatic nerve, which in combination with a saphenous nerve block will provide regional anaesthesia and/or analgesia for foot and ankle surgery. Division of the sciatic nerve into its branches, the common peroneal nerve and the tibial nerve, typically takes place around 6.5 cm above the popliteal crease. A catheter can be inserted to prolong the duration of analgesia. An online test is available for self-directed Continuous Medical Education (CME). It is estimated to take 1 hour to complete. Please record time spent and report this to your accrediting body if you wish to claim CME points. A certificate will be awarded upon passing the test. Please refer to the accreditation policy here.