Comparison of effect of intravenous Dexmedetomidine and Midazolam on preoperative sedation in paediatric patients undergoing elective surgery under general anaesthesia

One of the challenges in paediatric anaesthesia is to minimize distress for children in the OT room environment and to facilitate smooth induction of anaesthesia. This is often accomplished by prior administration of a sedative drug before transfer to the Operation room.Midazolam is the most common drug used for this purpose.(1) This is due to its sedative and anxiolytic properties (2). However, undesirable properties like restlessness and respiratory depression have made it a less than ideal premedication (3).

Dexmedetomidine is a newer alpha agonist with a more selective action on alpha adrenoceptor and a shorter half life (4). It provides sedation, anxiolysis and analgesia without respiratory depression (5).

The purpose of this study is to compare intravenous Midazolam and Dexmedetomidine as premedication in paediatric age group.

The null hypothesis of our study is that there is no significant difference between effect of intravenous Midazolam and Dexmedetomidine on preoperative sedation in paediatric patients undergoing elective surgery under general anaesthesia.

The study will be carried out in different Operation theatres of GMCH on paediatric patients in the age group 5-12 years.

References:

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

2. marshall J, Rodarte A, Blumer J, Khoo KC, Akbari B, Kearns G. Pediatric pharmacodynamics of midazolam oral syrup. Pediatric Pharmacology Research Unit Network. J Clin Pharmacol. 2000;40:578-89

3. Kanegaye JT, Favela JL, Acosta M, Bank DE. High dose rectal Midazolam for pediatric procedures: A randomized trial of sedative efficacy and agitation. Pediatr Emerg Care. 2003;19:329-36

4. Petroz GC, Sikich N, James M, van Dyk H, Shafer SL, Schily M. A phase 1, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology. 2006;105:1098-110

5. June JH, Kim KN, Kim JY, Song SM: The effects of intranasal Dexmedetomidine premedication in children: a systematic review and meta-analysis. Can J Anaesth. 2017, 9:947-961. 10.1007/s12630-017