Abstract
Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist.
 Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia.
 Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups.
 Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication.
 Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.
Highlights
Incidence of preopera ve anxiety in pediatric popula on is about 60-70%.1 Children become uncoopera ve, anxious, fearful especially at the me of separa on from parents, venepuncture, or mask applica on at the me of induc on
Emergence agita on was significantly lesser in pa ents who received dexmedetomidine premedica on
Dexmedetomidine is more effec ve in reducing emergence delirium in comparison to midazolam
Summary
Incidence of preopera ve anxiety in pediatric popula on is about 60-70%.1 Children become uncoopera ve, anxious, fearful especially at the me of separa on from parents, venepuncture, or mask applica on at the me of induc on. Preopera ve anxiolysis is an important part of pediatric anesthesia and is o en accomplished by prior administra on of a seda ve drug It minimizes distress in children entering the opera ng room and facilitates smooth induc on and recovery. Midazolam is one of the commonly used drugs for this purpose.[3,4] It has been used orally in the dose of 0.5mg/kg and has been found to be effec ve in reducing separa on and induc on anxiety, with minimal effect on recovery me.[5] But it is not the ideal premedicant in children as its use has been associated with undesirable effects including restlessness, paradoxical reac on, respiratory depression and nega ve postopera ve behavioral changes.6-8Dexmedetomidine is a newer α2agonist with a more selec ve ac on on the α2adrenoceptor that provides seda on, anxiolysis and analgesia with minimal respiratory depression. Looking at the posi ve results of dexmedetomidine premedica on in pediatric popula on this randomized double blind study was designed to compare this newer drug with the conven onally used premedicant midazolam in children
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