Intranasal dexmedetomidine versus intranasal midazolam as pre-anesthetic medication in pediatric age group undergoing ad
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Ain-Shams Journal of Anesthesiology
(2020) 12:40
ORIGINAL ARTICLE
Open Access
Intranasal dexmedetomidine versus intranasal midazolam as pre-anesthetic medication in pediatric age group undergoing adenotonsillectomy Bassem B. Saad, Ayman I. Tharwat, Haidi N. Ghobrial*
and Sanaa M. Elfawal
Abstract Background: The pre-operative period is a very stressful event for most of the individuals undergoing surgery especially the pediatric patients. So, relieving their pre-operative anxiety becomes an important concern for an anesthesiologist. Many anesthetic pre-medications are used to relieve this stress response. Of these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic medication in children. Forty-eight children aged 3–7 years, of either sex, weighing 13–22 kg, with American Society of Anesthesiologists (ASA) physical status 1 and undergoing elective adenotonsillectomy surgery were enrolled in this comparative prospective, double blinded, randomized clinical study. The children were divided into 2 groups: group D and group M, of 24 each. Forty-five minutes before induction of anesthesia, group D (n = 24) received intranasal dexmedetomidine at a dose of 1 μg/kg and group M (n = 24) received intranasal midazolam of 0.2 mg/kg. Results: Children who were pre-medicated with dexmedetomidine had lower sedation scores, lower anxiety levels, easier child-parent separation, better mask acceptance, and lower pain scores than those who received midazolam. The incidence of emergence agitation was decreased in both groups with no significant difference. Conclusion: Intranasal dexmedetomidine seems to offer some advantages compared with midazolam. Thus, it can be used effectively and safely as a pre-anesthetic medication in children undergoing any surgical procedures under general anesthesia. Keywords: Dexmedetomidine, Midazolam, Pediatric, Intranasal, Pre-medication
Background Pre-operative anxiety leads to hemodynamic instability, metabolic side effects, increased post-operative pain, and emergence agitation (Kumar & Ganguly, 2015). So, pharmacological measures are used to relieve presurgical anxiety and facilitate anesthetic induction without prolonging the recovery (Ghali et al., 2011). The pre-medicant used must have a non-traumatic, acceptable route of administration and be devoid of significant * Correspondence: [email protected] Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Abbassia, Cairo 11591, Egypt
side effects. Intranasal administration has been shown to be very effective, easy, non-invasive route with high bioavailability and rapid onset of action due to the high vascularization of the nasal mucosa (Wang & Bu, 2002). Midazolam, a water-soluble benzodiazepine, is widely used as a pre-anesthetic medication in children because it has a number of beneficial effects: sedation, anxiolysis, anterograde amnes
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