Comparative study of the effects of intranasal midazolam with intranasal dexmedetomidine as premedication in paediatric anaesthesia

Parthasarathy Mohanraj; M. C. Narendrababu

doi:10.18203/2320-6012.ijrms20241249

Authors

Parthasarathy Mohanraj Dharan Hospital, Salem, Tamil Nadu, India
M. C. Narendrababu Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241249

Keywords:

Anaesthesia, Dexmedetomidine, Intranasal, Midazolam, Paediatric, Premedication

Abstract

Background: Premedication in children is more acceptable with the intranasal route. In this study, we evaluated the efficacy of intranasal dexmedetomidine as premedication in paediatric surgeries as compared to intranasal midazolam.

Methods: This study was conducted in 60 patients of 6 to 12 years posted for tonsillectomy surgeries. Patients were randomly allocated into Group 1 and 2. Patient in group 1 (30) received 0.2mg/kg of intranasal midazolam as nasal drop using 1ml insulin syringe and similarly group 2 (30) received 1µg/kg of intranasal dexmedetomidine as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, pre oxygenation mask holding response score, post-operative agitation scores were evaluated.

Results: In our study, we observed that 76.7% of children in dexmedetomidine group attained better sedation compared to 46.7% in midazolam group. Anxiolytic effect in Group 1 (83.3%) was slightly better than in Group 2 (80%). 90% of the patients in dexmedetomidine group allowed easy pre oxygenation compared to 80% in midazolam group. Venipuncture response was better with dexmedetomidine group (86.7%) compared to midazolam group (73.3%). Postoperative agitation response in both the groups was same. The fall in HR, SBP was more with dexmedetomidine and there was no significant change in DBP in both the groups.

Conclusions: From our study, we concluded that premedication with intranasal dexmedetomidine is more effective than intra nasal midazolam in providing sedation. Both the drugs are effective in providing anxiolysis and better inducing condition. Therefore, intranasal dexmedetomidine is more efficacious than intranasal midazolam as premedication in children.

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References

Steward DJ. Preoperative evaluation and preparation for surgery. In: Paediatric 4th ed. Churchill Livingstone New York; 2002.

Rosenberg H, Goldberg M. Post operative emotional responses. In: complications in anaesthesiology. 2nd ed. Lippincot Raven publishers; 1996.

Kain ZN. Preoperative psychological trauma in children. In: Complications in anaesthesia. 1st ed. W.B. Saunders Company; 1999.

Kain ZN, Caldwell-Andrews AA, Krivutza DM, Weinberg ME, Wang SM, Gaal D. Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995–2002: results of a follow-up national survey. Anesth Analges. 2004;98(5):1252-9.

Watson AT, Visram A. Children’s preoperative anxiety and postoperative behavior. Paediatr Anaesth 2003;13:188-204.

Kain ZN, Mayes LC, Wang SM, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective?. J Amer Soci Anesthesiol. 1998;89(5):1147-56.

Deutsch ES. Tonsillectomy and adenoidectomy. Changing indications. Pediatr Clin North Am. 1996;43(6):1319-38.

Lindgren L, Saarnivaara L, Himberg JJ. Comparison of oral triclofos, diazepam and flunitrazepam as premedicants in children undergoing otolaryngological surgery. Brit J Anaesth. 1980;52(3):283-90.

Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children: predictors and outcomes. Arch Pedia Adolesc Medi. 1996;150(12):1238-45.

Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Premedication in children: a comparison of oral midazolam and oral clonidine. Pediat Anesth. 2007;17(12):1143-9.

Fazi L, Jantzen EC, Rose JB, Kurth CD, Watcha MF. A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient. Anesth Analg. 2001;92(1):56-61.

Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simões CM, Auler Jr JO. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth. 2007;17(7):667-74.

Wang J, Bu G. Influence of intranasal medication on the structure of the nasalmucosa. China Med J. 2002;115(4):617-9.

Abrams R, Morrison JE, Villassenor A. Safety and effectiveness of intranasal administration of sedative medications for urgent brief pediatric dental procedures. Anesth Prog. 1993;4:63-6.

Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Steal‐induction after clonidine premedication: a comparison of the oral and nasal route. Pediatric Anesthesia. 2007;17(3):230-4.

Walbergh EJ, Wills RJ, Eckhert J. Plasma concentrations of midazolam in children following intranasal administration. Anesthesiol. 1991;74(2):233-5.

Malinovsky JM, Populaire C, Cozian A, Lepage JY, Lejus C, Pinaud M. Premedication with midazolam in children - Effect of intranasal, rectal and oralroutes on plasma midazolam concentrations. Anaesthesia. 1995;50(4):351-4.

Yuen VM, Hui TW, Irwin MG, Yuen MK. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in paediatric anesthesia: a double-blinded randomized controlled trail. Anesth Analg. 2008;106(6):1715-21.

Khan ZP, Ferguson CN, Jones RM. α-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54(2):146-65.

Talon MD, Woodson LC, Sherwood ER, Aarsland A, McRae L, Benham T. Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. J Burn Care Res. 2009;30(4):599-605.

Eren G, Cukurova Z, Demir G, Hergunsel O, Kozanhan B, Emir NS. Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol. 2011;27(3):367-72.

Akin A, Bayram A, Esmaoglu A, Tosun Z, Aksu R, Altuntas R, Boyaci A. Dexmedetomidine vs midazolam for premedication of paediatric patients under going anesthesia. Paediat Anesthesia. 2012;22(9):871-6.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiol. 1992;77(6):1134-42.