Oral premedication for pediatric anaesthesia: a comparison between midazolam and clonidine

Authors

  • Anupam Das Department of Anaesthesia, Dr. B Borooah Cancer Institute, Guwahati
  • Kishore Das Department of Head and Neck Oncology, Dr. B Borooah Cancer Institute, Guwahati
  • Minoti Baruah Department of Anaesthesia, Dr. B Borooah Cancer Institute, Guwahati
  • Manigreeva Krishnatreya Department of Epidemiology and Biostatistics, Dr. B Borooah Cancer Institute, Guwahati
  • Amal Chandra Kataki Department of Gynecologic Oncology, Dr. B Borooah Cancer Institute, Guwahati

DOI:

https://doi.org/10.18203/2320-6012.ijrms20161812

Keywords:

Clonidine, Midazolam, Pediatric, Pre-medications

Abstract

Background:In children any anticipated surgery is associated with profound psychological stress to the patients. To allay this stress and anxiety, wide variety of pharmacological interventions are used.

Methods: A prospective observational study was carried out between July’2005 and June’2006 in a tertiary care hospital in Assam. The study included children undergoing surgery under general anaesthesia in age group 2-10 years. Sixty children were divided into two groups, in one group patients received oral midazolam and other group received oral clonidine as pre-medicant.

Results: In the midazolam group 23 (76.67%) children had no apprehension after parental separation and at induction (P˂0.001), sedation score at induction was significant higher in midazolam group versus clonidine group (93.33% versus 66.6%, P<0.01), clonidine resulted in a more stable pulse and blood pressure peri-operatively (P<0.05).

Conclusion: Oral midazolam has better efficacy in terms of preoperative sedation and oral clonidine had stable hemodynamic profile and better analgesia in the clonidine group.

References

Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during induction of anesthesia and postoperative behavioral outcomes. Anesth Analg. 1999;88:1042-7.

Goldparvar M, Saghaei M, Sajedi P, Razavi SS. Paradoxical reaction following intravenous midazolam premedication in pediatric patients: a randomized placebo controlled trial of ketamine for rapid tranquilization. Paediatr Anaesth. 2004;14:924-30.

Lönnqvist PA, Habre W. Midazolam as premedication: Is the emperor naked or just half dressed? Paediatr Anaesth. 2005;15:263-5.

McGraw T, Kendrick A. Oral midazolam premedication and postoperative behavior in children. Paediatr Anaesth. 1998;8:117-21.

Marhofer P, Glaser C, Krenn CG, Grabner CM, Semsroth M. Incidence and therapy of midazolam induced hiccups in pediatric anesthesia. Paediatr Anaesth. 1999;9:295-8.

Millar K, Asbury AJ, Bowman AW, Hosey MT, Martin K, Musiello T, et al. A randomized placebo controlled trial of the effects of midazolam premedication on children's postoperative cognition. Anaesthesia. 2007;62:923-30.

Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication. Acta Anaesthesiol Scand. 2006;50:135-43.

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

Alderson PJ, Lerman J. Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine. Can J Anaesth. 1994;41(3):221-6.

Desjardins R, Ansara S, Charest J. Pre-anaesthetic medication in paediatric day-care surgery. Can Anaesth Soc J. 1981;28(2):141-8.

Jones RD, Visram AR, Kornberg JP, Irwin MG, Gunawardene WM. Premedication with oral midazolam in children an assessment of psychomotor function, anxiolysis, sedation and pharmacokinetics. Anaesth Intensive Care. 1994;22(5):539-44.

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

Debnath S, Pandey Y. A comparative study of premedication in children with ketamine and midazolam. Ind J Anaesth. 2003;47(1):45-7.

Feld LH, Negus JB, White PF. Oral midazolam preanaesthetic medication in paediatric outpatients. Anaesthesiology. 1990;73:831-4.

Handa F, Fujii Y. The efficacy of oral clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery. Paediatric Anaesth. 2001;11:71-4.

Khalil S, Philbrook L, Rabb M, Wagner K, Jennings C, Chuang AZ. Sublingual midazolam premedication in children: a dose response study. Paediatric Anaesth. 1998;8:461-5.

Kothari. Oral midazolam for preanaesthetic medication in paediatric patients. Ind J Anaesth. 2000;44:58-9.

Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane induced agitation in children. Anaesth Analg. 2001;93:335-8.

American academy of paediatrics. Committee on drugs. Alternative routes of drug administration- advantages and disadvantages (subject review). Paediatrics. 1997;100:143-52.

Feld LH, Urquhart ML. Premedication in children: oral vs. intramuscular midazolam. Anaesthesiology. 1998;69:A745.

Geldner G, Hubmann M, Knoll R, Jacobi K. Comparison between three intramucosal routes of administration of midazolam in chidren. Paediatric Anaesth. 1997;7:103-9.

Karl HW, Rosenberger JL, Larach MG, Ruffle JM. Trans mucosal administration of midazolam for paediatric patients. Comparison of the nasal and sublingual routes. Anaesthesiology. 1993;78:885-91.

Nicholson SC, Betts EK, Jokes DR, Christianson, Walters JW, Mayes KR, et al. Comparison of oral and intramuscular preanaesthetic medication for paediatric inpatient surgery. Anaesthesiology. 1989;71:8-10.

Taylor MB, Vine PR, Hatch DJ. Intramuscular midazolam premedication in small children. Anaesthesia. 1986;41:21-6.

Karl HW, Keifer AT, Rosenberger JL, Larach MG, Ruffle JM. Comparison of the safety and efficacy of intranasal midazolam or sufentanyl for preinduction of anaesthesia in paediatric patients. Anaesthesiology. 1992;75:209-15.

Pandit UA, Collier PJ, Malviya S. Oral trans mucosal midazolam premedication for preschool children. Obst Paed Anaesth. 2000;191-5.

Maurice S, Rey E, Esteve C, de Lauture D, Olive G. The pharmacokinetics of rectal midazolam for premedication in children. Aansethesiology. 1986;65:536-8.

Reves JG, Fragen RJ, Vinik HR, Greenblatt DJ. Midazolam: pharmacology and uses. Anaesthesiology. 1985:62:310-24.

McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J. Premedication of children with oral midazolam. Can J Anaesth. 1992;39:545-50.

Mikawa K, Maekawa N, Nishina K, Takao Y, Yaku H, Obara H. Efficacy of oral clonidine premedication in children. Anaesthesiology. 1993;79:926-31.

Bergendahl HTG, Lonnqvist PA, Eksborg S. Clonidine vs. midazolam as premedication in children undergoin adeno-tonsillectomy: a prospective randomized, controlled clinical trial. Acta Anaesthesiol Scand. 2004;48:1292-300.

Weldon BC, Watcha MF, White PF. Oral midazolam in children: effect of time and adjunctive therapy. Anaesth Analg. 1992;75:51-5.

Fazi L, Jantzen EC, Rose JB, Kurth CD, Watcha MF. Comparison of oral clonidine and oral midazolam as preanaesthetic medication in paediatric tonsillectomy patients. Anaesth Analg. 2001;92:56-61.

Malde AD, Pageder RA, Jagtap SR. Oral clonidine in children: efficacy as premedicant and postoperative analgesic as compared to diazepam. Ind J Anesth. 2006;50(1):27-31.

Nishina K, Mikawa K, Shiga M, Obara H. Clonidine in paediatric anaesthesia. Paediatr Anaesth. 1999;9:187-202.

Wilton NC, Leigh J, Rosen DR, Pandit UA. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology. 1988;69(6):972-5.

Mikawa K, Nishina K, Maekawa N, Takao Y, Asano M, Obara H. Attenuation of the catecholamine response to tracheal intubation with oral clonidine in children. Can J Anaesth 1995;42:869-74.

Downloads

Published

2017-01-02

How to Cite

Das, A., Das, K., Baruah, M., Krishnatreya, M., & Kataki, A. C. (2017). Oral premedication for pediatric anaesthesia: a comparison between midazolam and clonidine. International Journal of Research in Medical Sciences, 4(6), 2341–2347. https://doi.org/10.18203/2320-6012.ijrms20161812

Issue

Section

Original Research Articles