Comparison of premedication with intranasal Dexmedetomidine and Fentanyl combination with Midazolam and Fentanyl combination in children

Premedication in children undergoing surgeries plays a pivotal role in alleviating anxiety, promote relaxation and facilitate smooth induction of anaesthesia. Various drugs have been used as premedication out of which Dexmedetomidine, a highly selective alpha 2  adrenoreceptor agonist has been increasingly used owing to its various benefits. Fentanyl is a synthetic opioid which acts on mu-opioid  receptors to produce analgesia. Midazolam is a benzodiazepam that causes sedation  , anterograde amnesia, and hypnosis by acting on GABA receptors on CNS. Here we are trying to compare intranasal drug combinations of Fentanyl  and Dexmedetomidine with Fentanyl and Midazolam as premedication in children aged 2-6 years  undergoing elective surgery under general anaesthesia. The methodology and  administration of drug shall be explained in detail with a written well informed consent from the parents. The children shall be divided into two groups of 30 each using block randomisation technique (Group I will receive intranasal Fentanyl 2mcg/kg and Dexmedetomidine 1 mcg/kg and Group II will receive Fentanyl 2mcg/kg and Midazolam 0.2 mg/kg) using mucosal atomising device. Patient will be taken to pre op room and baseline vitals shall be noted, child will be premedicated with allocated drug group and observed for 30-60 minutes , vital parameters and sedation score shall be noted then ease of parental separation shall be noted using appropriate scale. Patient shall be taken to ot, standard anaesthetic protocol shall be followed, sedation  score upon arrival and Mask acceptance score using appropriate scale, hemodynamic parameters shall be noted. After neuromuscular reversal, child will be shifted to post operative care unit and sedation score, FLACC Scale for postoperative pain and vital parameters shall be recorded every 15 minutes uptill 1 hour postoperatively.