Journal: Anesth Analg 106(6):1715-1721, 2008. 37 References
Reprint: Dept of Anaesthesiology, University of Hong Kong, Room 424, K Block, Queen Mary Hospital, Pokfulam Rd, Hong Kong (VM Yuen, MD) SO.04 SP0809/249 ©2008
Faculty Disclosure: Abstracted by S. Ouellette, who has nothing to disclose.
Oral midazolam is the most commonly used drug for premedication in pediatrics. Oral midazolam 0.5 mg/kg is effective in reducing both separation and induction anxiety in children with minimal effect on recovery. However, the acceptability of oral midazo¬lam is only 70%. Undesirable effects including restlessness, paradoxical reaction, and negative post¬operative behavioral changes have made it a less than ideal premedication. Although amnesia is considered an advantage, it is regarded as a disadvantage by some authors. Clonidine, an alpha2-agonist, has been used as an alternative for premedi¬cation. Oral cloni¬dine premedication in children has been shown to be equally as effective as midazolam and reduces emer¬gence agitation follow¬ing sevo¬flurane anesthesia.
Dexmedetomidine is a newer alpha2-agonist with a more selective action on the alpha2-adrenoceptor and a shorter half-life. Its bioavailability is 81.8% when administered via the buccal mucosa. It has been shown that intranasal 1 and 1.5 mcg/kg dexmed¬etomidine produces sedation in 45-60 min and peaks in 90-105 min. The purpose of this randomized, double-blind controlled study was to evaluate intra¬nasal dexmedetomidine and compare it to midazolam for premedication in children.
Ninety-six children, ASA PS 1 and 2, scheduled for elective minor surgery were randomized to one of three groups. Group M received midazolam 0.5 mg/kg in acetaminophen syrup and intranasal placebo. Group D0.5 and group D1 received dexmed¬etomidine 0.5 mcg/kg and 1 mcg/kg intranasally, respectively, and acetaminophen syrup. Patients' sedation status, behavior scores, blood pressure, heart rate, and oxygen saturation were recorded by an observer until induction of anesthesia. Recovery characteristics were also recorded.
There were no significant differences in parental separation acceptance, behavior score at induction and wake up score. When compared with group M, patients in group D0.5 and D1 were significantly more sedated when they were separated from their parents. Patients from group D1 were significantly more sedated at induction of anesthesia when compared with group M. It was concluded that intranasal dexmedetomidine produces more sedation than oral midazolam, but with similar and acceptable cooperation. |
