Abstract
Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction. Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time. Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001). Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.
Highlights
Preoperative anxiety remains a vexing issue, and it exists in nearly 50% of pediatric patients (Kain et al, 1999; Chorney and Kain, 2009)
Our preliminary study showed that the satisfactory compliance with inhalation induction was approximately 45% in patients who were premedicated with oral midazolam alone
We found that children who were premedicated with intranasal dexmedetomidine combined with oral midazolam had a significantly improved compliance rate during anesthesia inhalation induction and had faster onset to achieve the desired sedation than those premedicated only with intranasal dexmedetomidine or oral midazolam group
Summary
Preoperative anxiety remains a vexing issue, and it exists in nearly 50% of pediatric patients (Kain et al, 1999; Chorney and Kain, 2009). Midazolam has been one of the most popular premedications used today (Kain et al, 2004a; Kain et al, 2004b), and it has shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance during anesthesia induction (Kain et al, 1998; Kain et al, 2000). A study has shown that oral midazolam 0.5 mg.kg-1 could reduce anxiety at both moments of parental separation and induction of anesthesia (Cox et al, 2006). The technique with single oral midazolam may not be as good as clinicians highly expected in efforts to ease the preoperative anxiety and improve the smoothness of inhalation induction in children undergoing surgery. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time
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