Intranasal premedication with dexmedetomidine versus midazolam for pediatric patients in ophthalmic surgery: a randomized controlled study

Abstract

Background Excessive anxiety has a bad implication on anesthetic practice in pediatric anesthesia; therefore, decreasing anxiety by premedication is an important issue. Intranasal administration of various drugs is an easy route with rapid onset of action allowing administration of variable drugs such as midazolam and dexmedetomidine used in pediatric preoperative sedation. Patients and methods A total of 64 pediatric patients who were subjected to elective ophthalmic surgeries received either 0.5 mg/kg midazolam or 1 μg/kg dexmedetomidine intranasally. Basal heart and respiratory rate, blood pressure, sedation score, and oxygen saturation were recorded initially and every 5 min till the transfer to the operating room. Sedation score was also assessed at 30 min after drug administration. Postoperative monitoring was continued, and any postoperative complications were recorded. Results Oxygen saturation, heart rate, systolic blood pressure, and respiratory rate values showed insignificant differences when both groups were compared together but showed significance differences when compared with the basal value in each group separately after 30 min. Sedation score was faster and child–parents separation score was higher in dexmedetomidine group when compared with midazolam group, and also both groups showed significant sedation score less than 3 when compared with the basal value at 15, 20, 25, and 30 min. Conclusion Midazolam and dexmedetomidine were nearly equally effective as intranasal premedication for pediatric patients subjected to elective ophthalmic surgery with minimal adverse effects, and we recommend the use of midazolam owing to its safety, effectiveness, and lower cost.