Oral Dexmedetomidine Versus Midazolam as Anesthetic Premedication in Children Undergoing Congenital Heart Surgery

Abstract

Background:Premedication is required for reducing anxiety and child’s struggling against mask acceptance on anesthesia in pediatric surgery for congenital heart disease. Midazolam has been widely used for this purpose, but because of its side effects, finding an effective replacement with less complication is necessary.Objectives:In the present study, we compared the efficacy of oral midazolam versus dexmedetomidine in terms of anxiolysis and mask acceptance behavior.Patients and Methods:Sixty children aged between 2 and 12 years, and scheduled for on-pump surgery due to a congenital heart disease were randomly assigned into two groups. Oral midazolam (0.5 mg/kg up to 15 mg per patient) and dexmedetomidine (2 µg/kg) were administered 45 minutes pre-anesthesia. Children’s anxiety, mask acceptance behavior, hemodynamic measures, and cardiopulmonary outcomes were recorded and compared.Results:The mean age of patients was 3.96 ± 2.04 years. Twenty-eight (46.7%) patients were females. Two drugs have similar effects on cardiopulmonary outcomes and hemodynamic measures (P > 0.05). They equally relieved the children’s anxiety (mean sedation score 1.93 ± 0.63 and 2.0 ± 0.63 for midazolam and dexmedetomidine groups, respectively; P > 0.05), while dexmedetomidine showed a better effect on improving the mask acceptance behavior (mean mask acceptance score 2.58 ± 0.6 and 1.6 ± 0.67 for midazolam and dexmedetomidine, respectively; P < 0.05).Conclusions:It appears reasonable to apply oral premedication with dexmedetomidine 45 minutes before transferring the patient to the operating room when he or she is more prone to resist inhalation anesthesia induction.

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

“…Our study is consistent with the conclusions of the study by Jun et al e RSSs in the two groups showed sedation scores of 2 to 3, and satisfactory results were achieved in terms of separation from parents and mask acceptance. Faritus et al found that children that received preoperative oral administration of 0.5 mg/kg midazolam or 2 μg/kg dexmedetomidine can be easily separated from their parents and received an anesthesia mask without significant hemodynamic changes during congenital heart disease surgery [20]. Similarly, no significant difference in changes in blood pressure and HR were found between the two groups in our study.…”

Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

“…Dexmedetomidine is regarded as an effective drug to prevent PD attack due to its functions of antianxiety, improvement of sleep quality, and analgesia. [27][28][29] All enrolled patients in this study received routine dexmedetomidine infusion during surgery; meanwhile, dexmedetomidine was prohibited after surgery except for delirium occurrence. Therefore, all participants in this study had the same baseline for dexmedetomidine administration.…”

Efficacy and Safety of Midazolam Oral Solution for Sedative Hypnosis and Anti-anxiety in Children: A Systematic Review and Meta-Analysis

“…Four RCTs (Ghali et al, 2011;Liu et al, 2014;Faritus et al, 2015;Kumari et al, 2017) compared midazolam oral solution with dexmedetomidine, including 300 children. Two RCTs demonstrated no significant difference [MD = −0.07 to 0.08, P > 0.05].…”

“…A total 33 studies were included, including 20 RCTs, three cohort studies, nine case series, and one case report. The results of RCTs (Weldon et al, 1992;Mitchell et al, 1997;D'agostino and Terndrup, 2000;Luhmann et al, 2001;Younge and Kendall, 2001;Debnath and Pande, 2003;Horiuchi et al, 2005;Keidan et al, 2005;Mishra et al, 2005;Yildirim et al, 2006;Ashrafi et al, 2013;Derakhshanfar et al, 2013;Hijazi et al, 2014;Liu et al, 2014;Zhai et al, 2014;Faritus et al, 2015;Khodadad et al, 2016;Li et al, 2017;Salehi et al, 2017;You et al, 2018) and prospective cohort studies (Nathan and Vargas, 2002;Schmalfuss, 2005;Peretz et al, 2014) showed 189 cases of adverse drug reaction (ADR) and that the incidence of ADR was 19.57% (189/966). ADR involved the following: (1) mental system (lethargy, restless sleep, prolonged sedation, euphoria or restlessness, irritability, agitation, abnormal behavior, mood swings, headache, aggressiveness, and inner conflicts); (2) digestive system (nausea, vomiting, and hiccups);…”

“…For digestive system and other adverse reactions, no statistical difference was found. Four RCTs (Liu et al, 2014;Zhai et al, 2014;Faritus et al, 2015;Li et al, 2017) comparing midazolam oral solution with dexmedetomidine, with 260 children included, indicated that the incidence of adverse reactions in midazolam oral solution was higher [RR = 7.22, 95% CI (2.85, 18.28), I 2 = 0%, P < 0.05]. For the incidence of adverse effects of the mental system, midazolam oral solution was higher [RR = 12.00, 95% CI (2.93, 49.23), I 2 = 0%, P < 0.05] (Liu et al, 2014;Zhai et al, 2014;Li et al, 2017).…”