study of effect of dexmedetomidine nebulization on parental separation and mask acceptance in paediatric patients

Preoperativeanxiety is seen in 50%-70% of the paediatric patients posted for surgery. Fearof parent separation, fear of strange hospital environment and painfulprocedures contribute to preoperative anxiety.1Children with highpreoperative anxiety have high incidence of postoperative pain, emergencedelirium, delayed discharge and maladaptive and behavioural changes that canlast for weeks in the postoperative period.2

Variouspharmacological and non-pharmacological methods are in practice with variablesuccess rate. Drugs, such as midazolam and ketamine, have been tried forthis  via oral, nasal and parenteralroutes, but each one has its limitations.3

Inhalation of nebulised drug is an easyalternative for preoperative sedation in children as it avoids needle puncturenecessary for intravenous (IV) or intramuscular (IM) route. Dexmedetomidine,which is a selective alpha-2 agonist with central sedative and anxiolyticproperties,4 has been tried for preoperative anxiolysis in childrenvia nasal and inhalational routes.5 Previous study has suggestedthat nebulised dexmedetomidine can provide a clinically relevant, non-invasivealternative to the invasive IV or IM route of administration.6Thosestudies have used dexmedetomidine in the doses of 2 μg kg−1 and found that itwas effective in achieving calm parental separation in approximately 60%-70% ofchildren.7,8Dexmedetomidine in a dose of 3 µg kg−1 via parenteralroute has produced satisfactory procedural sedation without any haemodynamicadverse events.9,10