Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy

Abstract

IMPORTANCE Perioperative respiratory adverse events (PRAEs) are the most common complication during pediatric anesthesia, and they may be affected by the administration of preoperative sedatives. OBJECTIVE To investigate the effect of intranasal dexmedetomidine or midazolam used for premedication on the occurrence of PRAEs.

A novel nomogram for predicting respiratory adverse events during transport after interventional cardiac catheterization in children

“…Our study addresses an important knowledge gap in the medical literature regarding the incidence and predictors of RAEs during transport after this surgical procedure in pediatric patients. Previous scholars mainly focused on the construction of different prediction models for RAEs in the period of anesthesia induction, PACU or perioperative, and most of them were retrospective nature with insufficient efficacy ( 3 , 6 – 10 ). Our findings suggest that high rate of RAEs during transport deserves our sufficient attention and medical care in the context of the relative lack of medical resources.…”

“…The underlying biological mechanism is that atropine usage can reduce the production of airway secretions, thereby reducing the risk of RAEs. In the previous literature, the premedication used to prevent or minimize RAEs mainly includes sedative drugs and local anesthetics, such as dexmedetomidine, midazolam, and lidocaine topicalization of the airway ( 3 , 7 , 26 – 28 ). In our published study, we have confirmed that premedication with intranasal dexmedetomidine was an effective method to decrease the occurrence of RAEs in children with CHD ( 28 ).…”

“…Published studies concerning RAEs mainly focused on the period of anesthesia induction, intraoperative and post-anesthesia care unit (PACU), with relatively abundant medical resources (3,(6)(7)(8)(9)(10). However, little attention has been paid to the rate of RAEs during transport discharged from operating room after interventional cardiac catheterization in many pediatric anesthesia practice, which often lacks adequate resources for anesthesia care and monitoring.…”

“…Respiratory adverse events (RAEs) are the most common complication during pediatric anesthesia, characterized by both minor adverse events (oxygen desaturation, airway obstruction or secretions and cough) and major adverse events (laryngospasm, bronchospasm and apnea), with a reported prevalence of up to 50% ( 1 – 3 ). Despite the improvement of existing guidelines for pediatric anesthesia management, RAEs remain one of the leading causes of morbidity and mortality and bring varying levels of physical and psychological trauma to children and parents ( 4 , 5 ).…”

Perioperative Respiratory Adverse Events After Pediatric Adenotonsillectomy—Evaluating the Role of Preoperative Pharmacologic Anxiolysis

“…First, it is unknown whether standard medications, like dexamethasone, which is associated with reduced postoperative pain after AT, 8 were administered for all patients. Although the authors describe dexamethasone use for patients undergoing intravenous anesthesia induction, 1 it is unclear whether patients undergoing inhalation induction also received dexamethasone. Second, there is no discussion about the treatments used for children experiencing emergence delirium.…”