A Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anesthesia: A Double-Blinded Randomized Controlled Trial

摘要

Midazolam, the most frequently used premedication in children, has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an alpha 2 agonist, has been suggested as an alternative. Dexmedetomidine is a more alpha_2-selective drug that has more favorable pharmacokinetic properties than clonidine. A prospective, randomized, double-blind, controlled trial was designed to evaluate whether intranasal dexmedetomidine is as effective as oral midazolam for premedication in children. Ninety-six children with American Society of Anesthesiologists physical status I or II were scheduled for elective minor surgery and randomly assigned to 1 of 3 groups. Group M received 0.5 mg/kg of midazolam in acetaminophen syrup and intranasal placebo. Groups DO.5 and Dl were given 0.5 and 1 (JLg/kg, respectively, of intranasal dexmedetomidine and acetaminophen syrup. Patients' sedation status, behavior scores, blood pressure, heart rate, and oxygen saturation were recorded by an observer until induction of anesthesia. Recovery characteristics were recorded as well. No marked differences in parental separation acceptance, behavior score at induction, and wake-up behavior score were noted. Compared with group M, patients in groups DO.5 and Dl were markedly more sedated when they were separated from their parents. Patients in group Dl were markedly more sedated at induction of anesthesia compared with those in group M. The investigators concluded that intranasal dexmedetomidine produces more sedation than oral midazolam but with similar and acceptable cooperation.