Intranasal dexmedetomidine versus intranasal midazolam as pre-anesthetic medication in pediatric age group undergoing adenotonsillectomy

Abstract

Background The pre-operative period is a very stressful event for most of the individuals undergoing surgery especially the pediatric patients. So, relieving their pre-operative anxiety becomes an important concern for an anesthesiologist. Many anesthetic pre-medications are used to relieve this stress response. Of these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic medication in children. Forty-eight children aged 3–7 years, of either sex, weighing 13–22 kg, with American Society of Anesthesiologists (ASA) physical status 1 and undergoing elective adenotonsillectomy surgery were enrolled in this comparative prospective, double blinded, randomized clinical study. The children were divided into 2 groups: group D and group M, of 24 each. Forty-five minutes before induction of anesthesia, group D (n = 24) received intranasal dexmedetomidine at a dose of 1 μg/kg and group M (n = 24) received intranasal midazolam of 0.2 mg/kg. Results Children who were pre-medicated with dexmedetomidine had lower sedation scores, lower anxiety levels, easier child-parent separation, better mask acceptance, and lower pain scores than those who received midazolam. The incidence of emergence agitation was decreased in both groups with no significant difference. Conclusion Intranasal dexmedetomidine seems to offer some advantages compared with midazolam. Thus, it can be used effectively and safely as a pre-anesthetic medication in children undergoing any surgical procedures under general anesthesia.

A comparative evaluation of intranasal α2-adrenoceptor agonists and intranasal midazolam as premedication in pediatric sedation: A meta-analysis of randomized controlled trials

“…The included studies were published from 2011 to 2022, and a total of 1,495 eligible pediatric patients (ages ranged from 1 month to 14 years) were involved in present analysis. The primary outcomes “number of patients with satisfactory separation from parents, number of patients with satisfactory induction or mask acceptance, and patient’s level of sedation” were reported in 17 studies [ 14 – 21 , 23 – 26 , 28 – 30 , 32 , 33 ]. And most of studies paid attention on evaluation in midazolam versus dexmedetomidine, only one study focused on comparison between midazolam and clonidine [ 14 ].…”

“…[ 18 ], Saad BB et al . [ 30 ] and Abusinna RG et al . [ 33 ] demonstrated that both midazolam and dexmedetomidine provided positive sedative effects, and the proportion of patients with satisfactory sedation was also slightly higher in dexmedetomidine group compared to midazolam group (90.48% vs 71.43%, 100.00% vs 91.67%, and 78.00% vs 70.00%).…”

“…The results of Mitra S et al [14] study indicated that the proportion of patients with satisfactory sedation was slightly higher in the clonidine group compared to midazolam group (100% vs 83.33%). Surendar MN et al [18], Saad BB et al [30] and Abusinna RG et al [33] demonstrated that both midazolam and dexmedetomidine provided positive sedative effects, and the proportion of patients with satisfactory sedation was also slightly higher in dexmedetomidine group compared to midazolam group (90.48% vs 71.43%, 100.00% vs 91.67%, and 78.00% vs 70.00%). By contrast, the result of Neville DN et al study…”

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

“…[ 8 ] It has been widely used as a premedication in pediatric patients for procedural sedation and premedication, where it has shown promising results. [ 9 10 11 12 ] Hussain et al have reported in the literature that dexmedetomidine when administered through the nebulization route had reduced stress response to laryngoscopy and intubation. [ 13 ] Thomas D et al also reported that nebulized dexmedetomidine can attenuate the postoperative sore throat in patients.…”

Intranasal Dexmedetomidine Versus Midazolam as Sedative Premedication for Children in Day Case Surgery

“…Young children's minds are traumatized by their fears of the operation room, needles, and being apart from their parents before general anesthesia (1) . Preoperative anxiety increases postoperative pain and causes hemodynamic instability, metabolic side effects, and emerging agitation (2) .…”