Pre anaesthetic medication in children: A comparison of intranasal dexmedetomidine versus intranasal midazolam

Abstract

Background & objectives: Children are more anxious and fearful due to their limited cognitive capabilities, lack of understanding of health care system and lack of self control. It becomes an important concern for an anaesthesiologist to relieve their pre-operative anxiety. Midazolam is frequently used as premedication agent in children. New drugs such as the alpha-2 agonists have also been introduced as alternatives for premedication in pediatric patients. The present study was planned to compare intranasal Dexmedetomidine with intranasal Midazolam as a preanaesthetic medication in children with the primary objectives of assessing preoperative sedation & ease of child parent separation and secondary objectives of assessing analgesia in the postoperative period. Materials and methods: Seventy children, aged between 2-6 years of either sex,belonging to ASA Grade I & II and weighing between 10-16kg were enrolled in this prospective,single blinded, randomized and comparative clinical study. The children were divided into two groups of 35 each. Forty five minutes before induction, Group-D(n=35)-received intranasal Dexmedetomidine 1mcg/kg and Group M(n=35) –received intranasal midazolam 0.3mg/kg. Results: Children who were premedicated with intranasal dexmedetomidine had lower sedation (MOAA/S Scale) scores (P<0.0001), and easier child-parent separation than children who received intranasal midazolam. Postoperatively, less number of patients required rescue analgesia in the dexmedetomidine group. Conclusion: Intranasal Dexmedetomidine can be used effectively and safely as a preanaesthetic medication in children undergoing minor surgical procedures under General anaesthesia.

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 ].…”

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

“…Likewise, Singla et al (7) showed that the Modified Objective Pain Scale was significantly less at 30 min after intranasal dexmedetomidine. Midazolam produces sedation by stimulating GABA receptors in the cerebral cortex that inhibits normal neuronal function (8) .…”

Safety and Efficacy of Dexmedetomidine Nasal Spray for Pre-anaesthetic Sedation in Children: A Randomised, Double-Blinded, and Placebo-Controlled Trial

“…The intranasal route is convenient and relatively less invasive, avoids the rst-pass hepatic metabolism, and evokes rapid action at the central nervous system [9]. O abel intranasal administration of dexmedetomidine injection in children as drops by springe or as sprays by mucosal atomization device has been widely reported, where the satisfactory sedation with acceptable safety was observed [10][11][12].…”