A Comparative Study of Intranasal Dexmedetomidine and Intranasal Midazolam as Premedication in Children Undergoing Short Surgical Procedures

SUMMARY

This study was conducted in thedepartment of anesthesiology and critical care at the pediatric surgeryoperating theatre complex, St. John’s Medical College Hospital, Bangalore.

In this study, 104 ASA grade I andII children between 2-10 years, who were scheduled for elective surgicalprocedures were observed. The patients that received intranasal Dexmedatomidine(1µg/kg) were allotted to group D and the patients that received intranasalMidazolam (0.2mg/kg) were put under group M.

30 minutes after premedication withthe intranasal drug, the Parental Separation Anxiety Score was assessed on a 4point scale and sedation of the child was assessed using a 6 point ModifiedObserver’s Assessment of Alertness/Sedation Scale. Prior to anesthesiainduction the Mask Acceptance Score was assessed using a 5 point scale.

There was a marked variation betweenthe two groups with regards to the parental separation. There was astatistically significant data which concluded the children premedicated withintranasal Dexmedetomidine separated much more easily than those premedicatedwith intranasal Midazolam.

The Modified Observer’s Assessmentof Alertness/Sedation scores showed a significantly better score in theDexmedetomidine group compared to Midazolam, indicating a better degree ofsedation among those premedicated with Dexmedetomidine.

There was a statisticallysignificant difference with respect to mask acceptance before induction ofanesthesia. The patients premedicated with intranasal Dexmedetomidine had bettermask acceptance compared to those premedicated with intranasal Midazolam.

The demographic data recorded foundno difference in the age or gender between the two groups.

After premedication the childrenwere monitored for 30 minutes at every 10 minute interval, prior to inductionof anesthesia. Vital signs (heart rate, BP, respiratory rate and oxygensaturation) were recorded. After administering intranasal premedication it wasfound the there was a fall in heart rate, without significant fall in bloodpressure in the patients who were administered Dexmedetomidine. There was nochange in the respiratory rate or oxygen saturation.

Intra-operatively, the vitals weremonitored every 5 minute interval for 30 minutes and thereafter every 10minutes till the end of the procedure. The intra-operative period showed nosignificant variation in the vital parameters between the two groups.

Postoperatively the children were monitored for 24 hours after the procedure. Thevitals were stable and there were no adverse reactions in any of the children.

Therefore, based on these resultsit can be concluded that intranasal Dexmedetomidine (1 µg/kg) is moreefficacious than intranasal Midazolam (0.2 mg/kg) for premedicatingchildren undergoing short elective surgical procedures.