Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing Midazolam, Clonidine, and Dexmedetomidine

Bromfalk, Åsa; Hultin, Magnus; Walldén, Jakob; Myrberg, Tomi

doi:10.1016/j.jopan.2022.08.009

Cited by 3 publications

(5 citation statements)

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“…A total of 11 articles (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) were entered into this metaanalysis (Figure 1), involving 415 cases in the intranasal Dex group and 369 cases in the oral midazolam group. The basic characteristics of the included studies are shown in Table 1.…”

Section: Literature Search Results and Featuresmentioning

confidence: 99%

“…Two records reported the incidence of adverse events (22,23). The meta-analysis results illustrated no significant difference in the incidence of adverse events between the intranasal Dex group and the oral midazolam group (RR = 0.25, 95% CI: 0.06-1.13, P = 0.072; Figure 6).…”

Section: Incidence Of Adverse Eventsmentioning

confidence: 98%

“…Four studies compared the incidence of postoperative analgesic remedies (16,17,19,23). The meta-analysis results (Figure 4) showed that there was no difference in the incidence of postoperative analgesic remedy in the intranasal Dex group compared with the oral midazolam group (RR = 0.60, 95% CI: 0.36-1.00, P = 0.051).…”

Section: Postoperative Analgesic Remedymentioning

confidence: 99%

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Intranasal dexmedetomidine vs. oral midazolam for premedication in children: a systematic review and meta-analysis

Zhang,

Xin,

Yin

2023

Front. Pediatr.

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ObjectiveTo compare the effects of intranasal dexmedetomidine (Dex) and oral midazolam in the preoperative medication of children by using a method of meta-analysis.MethodsCochrane Library, Pubmed, Embase, and Web of Science were searched from inception to July 2023. Randomized controlled trials (RCTs) of intranasal Dex vs. oral midazolam in pediatric premedication were collected. Stata 15.0 statistical software was used to analyze the collected data. Relative risk (RR) and 95% confidence interval (CI) were used as effect sizes.ResultsA total of 11 studies with 824 children were included, containing 415 patients in the Dex group and 409 patients in the midazolam group. Compared with the oral midazolam group, the intranasal Dex group had a better preoperative sedation effect at parent-child separation (RR = 1.37, 95% CI: 1.14–1.64) and anesthesia induction (RR = 2.08, 95% CI: 1.03–4.22). In addition, there was no significant difference in the incidence of analgesia remedy (RR = 0.60, 95% CI: 0.36–1.00) the acceptance of anesthesia masks (RR = 0.97, 95% CI: 0.83–1.12), and incidence of adverse events between (RR = 0.25, 95% CI: 0.06–1.13, P = 0.072) between the intranasal Dex and oral midazolam groups.ConclusionCompared with oral midazolam, intranasal Dex has better sedative effects of parent-child separation and anesthesia induction in pediatric premedication, but there was no difference in the incidence of anesthesia remedy, anesthesia mask acceptance, and incidence of adverse events. Therefore, compared with oral midazolam, intranasal Dex is a better choice for premedication in children.

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Section: Literature Search Results and Featuresmentioning

confidence: 99%

Section: Incidence Of Adverse Eventsmentioning

confidence: 98%

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Intranasal dexmedetomidine vs. oral midazolam for premedication in children: a systematic review and meta-analysis

Zhang,

Xin,

Yin

2023

Front. Pediatr.

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“…Aspects of preoperative anxiety and perioperative cardiac response in the trial cohort were previously published. 8,9 The study protocol followed Good Clinical Practice and was approved by the…”

Section: Methodsmentioning

confidence: 99%

“…This study was a preplanned secondary analysis of a double‐blinded clinical trial evaluating premedications in preschool‐aged children undergoing anesthesia for ENT surgery at Sunderby Hospital, Luleå, Sweden, from February 2017 to May 2019. Aspects of preoperative anxiety and perioperative cardiac response in the trial cohort were previously published 8,9 . The study protocol followed Good Clinical Practice and was approved by the Regional Ethic Review Board in Umeå (Dnr 2016‐46‐31M, March 30, 2016, chair: A Iacobæus) and the Swedish Medical Products Agency (Dnr 5.1‐2016‐17854, May 13, 2016).…”

Section: Methodsmentioning

confidence: 99%

Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine

Bromfalk

Hultin

Myrberg

et al. 2023

Pediatric Anesthesia

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BackgroundPreoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol‐remifentanil anesthesia have not been studied in preschool‐aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.MethodsIn this prespecified secondary analysis of a double‐blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.ResultsAfter excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.ConclusionsNo statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2‐agonists had a better recovery profile than short‐acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

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Perioperative Staff’s Experiences of Premedication for Children

Bromfalk,

Hultin,

Walldén

et al. 2024

Journal of PeriAnesthesia Nursing

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Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing Midazolam, Clonidine, and Dexmedetomidine

Cited by 3 publications

References 24 publications

Intranasal dexmedetomidine vs. oral midazolam for premedication in children: a systematic review and meta-analysis

Intranasal dexmedetomidine vs. oral midazolam for premedication in children: a systematic review and meta-analysis

Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine

Perioperative Staff’s Experiences of Premedication for Children

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