BackgroundPerioperative anxiety is common in pediatric patients undergoing surgery.AimsThe aim of this study was to determine whether an infusion of dexmedetomidine prior to hernia repair in children provides better postoperative anxiety outcomes that a preoperative infusion of midazolam.MethodsNinety 6‐11‐year‐old children, who were scheduled to undergo elective hernia repair, were enrolled for this double‐blind, randomized controlled trial. Group D (n = 45) received an intravenous infusion of dexmedetomidine (0.5 μg/kg) and Group M (n = 45) received an intravenous infusion of midazolam (0.08 mg/kg) in 20 mL of normal saline for 10 minutes before the induction of anesthesia. Pre‐ and postoperative scores on the modified Yale Preoperative Anxiety Scale were the main outcomes. Secondary outcomes included systolic blood pressure, diastolic blood pressure, heart rate, and postoperative pain measured on a visual analogue scale and patient satisfaction using a numerical rating scale.ResultsPostoperative anxiety in Group D was significantly lower than preoperative anxiety (2 hours postoperatively mean difference [95% CI]: 2.83 [0.87‐4.79], P = 0.036, 4 hours postoperatively mean difference [95% CI]: 3.29 [1.39‐5.20], P = 0.005). Preoperative and postoperative anxiety in Group M was similar. Anxiety scores in Group D were also significantly lower than anxiety in Group M 2 hours (mean difference [95% CI]: 1.89 [0.52‐3.26], P = 0.01) and 4 hours (mean difference [95% CI]: 3.32 [1.98‐4.66], P < 0.001) postoperatively. Systolic blood pressure, diastolic blood pressure and heart rate were lower in Group D than in Group M after administration of sedative drugs until children left PACU (SBP mean difference [95% CI]: 13.87 [10.30‐17.43], P < 0.001, DBP mean difference [95% CI]: 5.96[3.80‐8.11], P < 0.001, HR mean difference [95% CI]: 10.36 [7.58‐13.13], P < 0.001). Pain was also significantly lower in Group D than in Group M at 2 hours (median difference [95% CI]: 1 [0.26‐1.34], P = 0.004), 4 hours (median difference [95% CI]: 1 [0.31‐1.02], P = 0.003), and 1 day (median difference [95% CI]: 0 [0.22‐0.76], P = 0.003) postoperatively. Patient satisfaction scores were significantly higher in Group D than in Group M 1 day (median difference [95% CI]: 0 [−0.83 to −0.24], P = 0.006) and somewhat higher 1 week (median difference [95% CI]: 0 [−0.67 to −0.04], P = 0.06) postoperatively.ConclusionCompared with midazolam, a single preoperative intravenous dose of dexmedetomidine appears to provide better postoperative anxiolytic effects for children undergoing same‐day surgery.

Background Surgery results in systemic inflammation, which can affect the central nervous system, leading to changes in mood, emotion, and behavior. Our previous study has shown that compared to midazolam, dexmedetomidine premedication effectively decreased children's postoperative anxiety. Aim To investigate whether dexmedetomidine infusion before hernia repair alleviates postoperative systemic inflammation in children and whether postoperative anxiety may be associated with postoperative inflammation. Methods This prospective double‐blind randomized controlled trial was conducted in 120 children scheduled to undergo elective hernia repair. Before anesthesia induction, all children received an intravenous infusion consisted of dexmedetomidine (n = 40; 0.5 µg/g, group D), midazolam (n = 40; 0.08 mg/kg, group M), or normal saline (n = 40; group C). One‐way ANOVA with least significant difference multiple comparison test was used for multigroup comparisons of postoperative plasma levels of inflammatory cytokines and m‐YPAS scores. Spearman rank correlation tests were used for analyzing m‐YPAS scores with postoperative plasma levels of inflammatory cytokines. Results Plasma levels of tumor necrosis factor‐alpha (7.0 ± 1.6 vs. 8.1 ± 1.6, mean difference [95% CI]: 1.19 [0.26–2.11], p = .008) (pg/ml) and of interleukin‐6 (1.8 ± 1.2 vs. 3.3 ± 1.6, mean difference [95% CI]: 1.49 [0.74–2.25], p < .001) (pg/ml) and neutrophils‐to‐lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.7, mean difference [95% CI]: 0.48 [0.17–0.78], p < .001) were significantly lower in group D than in group C. Furthermore, compared to group M, group D showed significantly lower plasma tumor necrosis factor‐alpha levels (7.0 ± 1.6 vs. 7.9 ± 1.9, mean difference [95% CI]: 0.96 [0.04–1.88], p = .04) (pg/ml) and interleukin‐6 levels (1.8 ± 1.2 vs. 2.9 ± 1.5, mean difference [95% CI]: 1.06 [0.31–1.81], p = .004) (pg/ml), and neutrophil‐to‐lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.6, mean difference [95% CI]: 0.42 [0.11–0.72], p = .004). Anxiety scores at postoperative 2 and 4 h in the three groups positively correlated with plasma levels of proinflammatory cytokines. Conclusion A single preoperative intravenous dexmedetomidine dose in children undergoing same‐day surgery reduces postoperative systemic inflammation.