Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children

Abstract

Several studies have reported that sevoflurane was associated with a relatively high incidence of emergence agitation in children even in the absence of any surgical intervention. The aim of this study was to compare early agitation characteristics of oral melatonin, dexmedetomidine, and midazolam premedication in children who were given sevoflurane anesthesia for esophageal dilatation. Following Internal Review Board approval and parental informed consent, 100 ASA physical status I-II children (3-9years old) who were scheduled to undergo general anesthesia for esophageal dilatation procedures were enrolled. The patients were randomly assigned to four groups (n=25 in each). The premedications in the groups were saline (group P), dexmedetomidine 2.5μg/kg (group D), 0.5mg/kg midazolam (group MD), and melatonin 0.1mg/kg (group ML), given orally. All premedication drugs were given with paracetamol 2-2.5mg/kg to be easily drinkable 40-45min before anesthesia induction. Anesthesia was maintained with sevoflurane 2-4%, N(2)O 50% in oxygen. No supplemental analgesic agent was given, and an emergence agitation scale (EAS) was measured on admission to the PACU, then every 5 min, and recorded during the postoperative period: 1, awake and calm, cooperative; 2, crying, requires consoling; 3, irritable/restless, screaming, inconsolable; 4, combative, disoriented, thrashing. Children with an agitation score of 3 or 4 were classified as agitated. There were no significant differences among the four groups demographically. The emergence agitation scale was higher in the placebo group than in the others at 5, 10, and 15min postoperatively (P<0.001). EA was similar among group D, group MD, and group ML. We found that oral melatonin, dexmedetomidine, and midazolam reduced the incidence of emergence agitation in children after sevoflurane anesthesia.