A comparative study of intranasal dexmedetomidine and intranasal midazolam for premedication - A prospective randomized double-blind study in children posted for tonsillectomy

Abstract

Preanesthetic medication in paediatric patients is well known to be a challenge for anaesthesiologists. Premedication in paediatric population helps to produce a relaxed state with reduced anxiety and increased compliance as well as to ease separation from parent and allowing the patient to tolerate and co-operate with the necessary procedure. Our aim is to do a comparation of dexmedetomidine and midazolam given via intranasal route in children posted for tonsillectomy as premedication.This study was conducted in 100 patients of 6 to 12 years posted for tonsillectomy. Patients were randomly allocated into Group M and D. Patient in group M (50) received 0.2mg/kg of midazolam administered intranasally as nasal drop using 1ml insulin syringe and similarly group D (50) received 1µg/kg of dexmedetomidine administered intranasally as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, mask induction score, post-operative agitation score was assessed.Satisfactory sedation was achieved by 86% and 68% of patient in dexmedetomidine and midazolam respectively p (0.03). Satisfactory mask induction was achieved by 84% and 70% of patient in dexmedetomidine and midazolam respectively p (0.09). In terms of post op agitation score there is no difference in both the group p (0.30). During the time between administration of pre op drugs and initiation of anaesthesia, no patient seems to develop hypotension, hypoxia or any other life-threatening complicationIn our study we concluded that in terms of decreasing anxiety at parental separation both dexmedetomidine and midazolam were found to be equally effective. However, Intranasal dexmedetomidine produced superior sedation scores at separation and induction compared to oral midazolam in paediatric patients.