Oral Dexmedetomidine Research Articles

Effects of oral dexmedetomidine on incidence of anxiety and emergence delirium in surgical and non-surgical anesthesia in preschool children

ABSTRACT Background Anxiety and emergence delirium (ED) are common complications of anesthesia in preschool children. Several causes had been attributed to them. Emergence delirium might be related to preoperative anxiety. We aimed to detect the incidence of anxiety and emergence delirium in anesthesia for surgical and non-surgical procedures, also to detect if oral dexmedetomidine as a premedication affects the incidence and severity of them in these procedures. Methods The study involved 180 children undergoing anesthesia who were randomly assigned to one of four groups, with each group containing 45 children. The study was clinical, controlled, comparative, and prospective. Groups A1&A2 had surgical intervention, while groups B1&B2 had MRI scanning. Groups A1&B1 were given 20 ml plain apple juice (Placebo) and groups A2&B2 received oral Dexmedetomidine (4 µg/kg) inserted in 20 ml apple juice 45 minutes prior to anesthesia induction. Anxiety was assessed pre-procedural, emergence delirium and pain at different intervals post-anesthesia. Results Incidence of anxiety and emergence delirium showed no difference between surgical and non-surgical procedures. Patients who received oral dexmedetomidine in groups A2 and B2 had significantly lower Parental Separation Anxiety scores than corresponding control groups A1 and B1 (p = 0.001). Occurrence of emergence delirium and severe pain were much decreased in groups received dexmedetomidine. PAED and FLACC exhibited significantly reduced scores in groups received dexmedetomidine than groups received Placebo drug (p < 0.05) in both surgical and non-surgical procedures. Rescue analgesia was needed more significantly for patients in groups A1 and B1 relative to other groups (p = 0.002). The incidence of complications revealed no statistical significance. Conclusion Anxiety and emergence delirium were similar in surgical and non-surgical procedures. Premedication of preschool children with oral dexmedetomidine lowered the frequency and intensity of anxiety, emergence delirium and severe pain. Emergence delirium was correlated to pain, especially in surgical procedures.

Alpha-2-adrenergic agonists reduce resting energy expenditure in humans during external cooling

ABSTRACT Intravenous alpha-2-adrenergic receptor agonists reduce energy expenditure and lower the temperature when shivering begins in humans, allowing a decrease in core body temperature. Because there are few data about similar effects from oral drugs, we tested whether single oral doses of the sedative dexmedetomidine (1 µg/kg sublingual or 4 µg/kg swallowed) or the muscle relaxant tizanidine (8 mg or 16 mg), combined with surface cooling, reduce energy expenditure and core body temperature in humans. A total of 26 healthy participants completed 41 one-day laboratory studies measuring core body temperature using an ingested telemetry capsule and measuring energy expenditure using indirect calorimetry for up to 6 hours after drug ingestion. Dexmedetomidine induced a median 13% – 19% peak reduction and tizanidine induced a median 15% – 22% peak reduction in energy expenditure relative to baseline. Core body temperature decreased a median of 0.5°C – 0.6°C and 0.5°C – 0.7°C respectively. Decreases in temperature occurred after peak reductions in energy expenditure. Energy expenditure increased with a decrease in core temperature in control participants but did not occur after 4 µg/kg dexmedetomidine or 16 mg tizanidine. Plasma levels of dexmedetomidine but not tizanidine were related to mean temperature change. Decreases in heart rate, blood pressure, respiratory rate, cardiac stroke volume index, and cardiac index were associated with the change in metabolic rate after higher drug doses. We conclude that both oral dexmedetomidine and oral tizanidine reduce energy expenditure and allow decrease in core temperature in humans.

Oral Dexmedetomidine Achieves Superior Effects in Mitigating Emergence Agitation and Demonstrates Comparable Sedative Effects to Oral Midazolam for Pediatric Premedication: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Background: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. Methods: This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. Results: A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine (n = 162) than in those receiving midazolam (n = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; p < 0.001; I2 = 35%). Conclusions: Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam.

Niche Roles for Dexmedetomidine in the Intensive Care Unit.

Review dexmedetomidine use in critically ill patients for niche indications including sleep, delirium, alcohol withdrawal, sepsis, and immunomodulation. Literature was sought using PubMed (February 2012-November 2022). Search terms included dexmedetomidine AND (hypnotics OR sedatives OR sleep OR delirium OR immunomodulation OR sepsis OR alcohol withdrawal). Relevant studies conducted in humans ≥18 years published in English were included. Exclusion criteria included systematic reviews, meta-analyses, and studies evaluating oral dexmedetomidine or other alpha-2 agonists. A total of 231 articles were retrieved. After removal of duplicates, title and abstract screening, and application of inclusion criteria, 35 articles were included. Across the clinical conditions included in this review, varying clinical outcomes were seen. Dexmedetomidine may improve morbidity outcomes in delirium, sleep, and alcohol withdrawal syndrome. Due to limited human studies and poor quality of evidence, no conclusions can be drawn regarding the role of dexmedetomidine in immunomodulation or sepsis. This review presents data for potential niche roles of dexmedetomidine aside from sedation in critically ill patients. This may serve as a guide for sedation selection in critically ill patients who may also benefit from the pleiotropic effects of dexmedetomidine due to a clinical condition discussed in this review. While further studies are needed, dexmedetomidine may provide benefit in other indications in critically ill patients including delirium, sleep, and alcohol withdrawal. Given the poor quality of evidence of dexmedetomidine use in immunomodulation and sepsis, no conclusions can be drawn.

Dexmedetomidine premedication increases preoperative sedation and inhibits stress induced by tracheal intubation in adult: a prospective randomized double-blind clinical study

ObjectiveThe aim of this prospective randomized double-blind study is to evaluate whether oral dexmedetomidine (DEX) premedication could increase sedation in order to reduce preoperative anxiety and inhibit stress response during general anesthesia tracheal intubation.MaterialsA total of 100 ASA I and II adult patients undergoing elective neurosurgery were randomly divided into the control group (C group, n = 50) and the oral DEX premedication (DEX group, n = 50). Patients were administrated 4 μg/kg dexmedetomidine orally pre-anesthesia 120 min. Hemodynamic variables were monitored and recorded from premedication to 10 min after tracheal intubation. The primary outcome, the sedation level of all participants, was evaluated by Richmond Agitation Sedation Scale (RASS), and Numerical Rating Scale was to measure their intensity of thirst and satisfaction of patients’ family members. During general anesthesia induction, the total dosage of induction anesthetics and complications relative to anesthesia induction were recorded. After tracheal intubation, blood sample was drain from radial atrial line to measure levels of adrenocorticotropic hormone (ACTH) and cortisol.ResultsRASS scores at 60 min after premedication and on arrival in the operating room were significantly reduced in the DEX group (P < 0.001). Oral DEX premedication not only increased the intensity of thirst but also the satisfaction of their family members (P < 0.001). The cortisol level after tracheal intubation was deduced by oral DEX premedication (P < 0.05). Oral DEX premedication reduced heart rate (HR) and mean arterial pressure (MAP) on arrival in the operating room, and HR when tracheal intubation (P < 0.05). During the whole process of anesthesia induction, although the lowest MAP in two groups were not significantly different, the lowest HR was significantly lower in the DEX group (P < 0.05). Oral DEX premedication might reduce HR from premedication to 10 min after tracheal intubation. However MAP was reduced just from premedication to on arrival in the operating room. Total induction dosages of propofol, midazolam, sulfentanil and rocuronium were similar in two groups (P > 0.05), as well as the complications relative to anesthesia induction and cases of rescue dopamine therapy were similar (P > 0.05).ConclusionOral DEX 4 μg/kg premedication was an efficient intervention to increase preoperative sedation and reduce stress reaction induced by general anesthesia tracheal intubation, but also it was with the stable hemodynamic during the process of general anesthesia tracheal intubation, and improved the satisfaction of patients’ family members. In this study, the sparing-anesthetic effect of 4 μg/kg DEX oral premedication was not significant, and this would be needed to study in future.Trial registrationThis trail was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn, Jie Gao) on 15/04/2021, registration number was ChiCTR2100045458.

COMPARISON OF ORAL MIDAZOLAM,ORAL DEXMEDETOMIDINE AND ORAL MIDAZOLAM KETAMINE COMBINATION FOR PREMEDICATION IN PAEDIATRIC SURGERY

Background: Children especially age group &lt;10years undergoing operation may experience preoperative anxiety &amp; may be uncooperative.This uncooperative behavior of children may be observed at the time of separation from parents, venipuncture or mask application. Untreated anxiety may lead to difficult induction, greater rescue analgesic needs, emergence delirium (ED), behavioural &amp; postoperative psychological effects. An atraumatic premedication, calm separation from parents can minimize these problems and a smooth induction of anaesthesia can be achieved.Method : Prospective randomized double blind active controlled study was conducted in Government medical college &amp; hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. 75 ASA I &amp; II subjects aged between 2 to 5 year weighing less than 15 Kg posted for elective paediatric surgery under general anaesthesia at tertiary care centre were selected. They were randomly allocated into 3 groups Group M ,Group M K &amp; Group D with 25 subjects in each group using computer generated randomization list. Oral premedication was given in each group 30 minutes before surgery.Baseline heart rate,SBP and RR measured before administering premedication and at 10 minutes intervals up to 30 to 45 minutes after premedication. Results: Sedation &amp; anxiolysis score at induction[S1] was significant higher in Group M K&amp; Group D [p Value &lt;0.05] compared to Group M. Sedation at the time of separation from parents [S2] was better in Group M K &amp; Group D compared to Group M[p Value &lt;0.05].Sedation during Mask Acceptance[S3] was better in Group M K &amp; Group D compared to Group M[p Value &lt;0.05].Wake up Behaviour [when the patient recovers from anaesthesia at end of surgery [S4] ] was assessed &amp; Subjects were more Sedated[post anaesthesia] in Group D when compared to Group m &amp; Group M K[p Value &lt;0.05]. Time taken for maximum change in vital parameters was more in Group D followed by Group M K and Group M respectively p Value 0.001].There was significant changes in Vital parameters in Group D compared to Group M &amp; Group M K .Bradycardia p Value 0.00044] &amp; Hypotension [p Value 0.01]was more significant in Group D when compared to Group MK &amp;Group M Conclusion: Oral Midazolam (0.2mg/kg) &amp; Ketamine (2mg/kg) combination &amp; oral Dexmedetomidine (0.5 g/kg) both provide satisfactory sedation levels &amp; offers significant ease of separation from parents with satisfactory mask acceptance in children&lt;10 years compared to oral Midazolam alone.

A comparison of midazolam, dexmedetomidine 2µg/kg and dexmedetomidine 4µg/kg as oral premedication in children, a randomized double-blinded clinical triall

Background: The objective of this study was to analyze an oral administration of midazolam with two different doses of dexmedetomidine for premedication in paediatric patients. Methods: A prospective, randomized, double blind study. Three hundred patients, aged 1-7 years, undergoing elective surgery under general anesthesia were recruited for the study. Patients were randomized into three groups to receive oral midazolam 0.5mg/kg (group M), oral dexmedetomidine 2 µg/kg (group D2) and oral dexmedetomidine 4 µg/kg (group D4) for premedication. An observer blinded to the patient group allocation assessed level of sedation at 30 minutes after giving the premedication, ease of parental separation was assessed while shifting the patients to the operating room, mask acceptance during induction and postoperative agitation scores in post anesthesia care unit. Results: The sedation score of group D4 was significantly higher than group D2 and group M [ group D4- 4 (4,3), group D2- 2(2,2) and group M -2(3,2), H statistics = 80.4718, p &lt; 0.00001]. The parental separation score, mask acceptance score and postoperative was also significantly better for group D4 compared to the other two group. Conclusion: These results suggest that oral dexmedetomidine 4 µg/kg is more effective than oral midazolam 0.5mg/kg and oral dexmedetomidine 2 µg/kg for premedication in children.

Perioperative Low Dose Dexmedetomidine and Its Effect on the Visibility of the Surgical Field for Middle Ear Microsurgery: A Randomised Controlled Trial.

Background and Purpose: There are many benefits of administering dexmedetomidine perioperatively. The pharmacokinetics (PK) and pharmacodynamics (PD) of intravenous, intranasal and oral dexmedetomidine that was administered before anesthesia were compared in this study, and the effects of dexmedetomidine on the surgical field visibility in tympanoplasty was evaluated. Methods: A single-blind, randomized controlled trial was conducted in a university-affiliated hospital where 45 patients who underwent tympanoplasty under general anesthesia were randomly allocated into three groups. Dexmedetomidine was administered by intravenous infusion at 0.8 μg.kg−1 for 10 min, intranasal instillation at a drop rate of 1 μg.kg−1 and oral intake at 4 μg.kg−1 ten minutes before the induction of anesthesia. The PK and PD of dexmedetomidine after a single low dose administration and its effect on the surgical field in tympanoplasty were analysed. Results: A plasma concentration of dexmedetomidine of 220 pg/ml was achieved immediately after intravenous infusion and at 13.2 and 70.3 min for intranasal and oral administration, respectively. Dexmedetomidine decreased the heart rate (HR) and mean arterial pressure (MAP) in all three groups, although these values remained higher in the oral dexmedetomidine group at all eight time points. Intravenous dexmedetomidine provided the best visualization of the surgical field for opening of the tympanic sinus, 30 min after the start of the infusion (p < 0.05). Intranasal dexmedetomidine provided a significantly better visual field than oral dexmedetomidine for the repair of a tympanic membrane perforation using the fascia temporal muscle (p < 0.05). Conclusion: A single low dose of dexmedetomidine administered intravenously or intranasally could decrease HR and MAP, improve surgical field visibility and be appropriate for deliberate hypotension for surgical procedures of 1–2 h in length. Trial registration: Clinicaltrials.gov identifier: NCT03800641.

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children.

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children.

Analgesia for the Change of Dressing in Burn Victims: A Comparison Between Oral Ketamine and Oral Dexmedetomidine

Objective: To compare the efficacy of oral ketamine with oral dexmedetomidine for providing adequate analgesia for change of dressing in burn patients in burn dressing room. Methods: This randomized controlled trial was carried out in Jinnah Burn and Reconstructive Surgery Center, Lahore, from April 2019 to September 2019 after getting the approval from the Ethical Committee of Jinnah Hospital / Allama Iqbal Medical College, Lahore. 80 patients between 20 to 50 years, with 1st and 2nd degree burns and 20 to 40% of total body surface area involved were allocated in two groups A and B. The patients in group A received oral ketamine at a dose of 5mg/kg in 15 ml of water 30 mins while those in group B received dexmedetomidine, 4 ug/kg orally, in 15 ml of water 30 mins before the start of dressing change. The change of dressing was carried out with continuous vital monitoring. Pain was assessed via visual analogue scale (VAS) and sedation via Ramsay sedation score. All the observations were recorded on the predesigned proforma. SPSS version 21 was used for data analysis. Result: The baseline mean VAS score of patients in group A was 7.67 + 0.55 and in group B was 7.70 + 0.57 (p value = 0.799). Significant decrease in pain score in both groups was noted after 30 mins of drugs administration (p=0.000). Also a significant difference in pain scores was seen between the two groups (p&lt; 0.05), with the patients in group A having lower pain scores as compared to patients in group B. Conclusion: both ketamine and dexmedetomidine provide adequate analgesia for the change of burn dressing when administered orally with ketamine providing better analgesic state as compared to dexmedetomidine. Key Words: Burn, ketamine, dexmedetomidine, analgesia. How to cite: Sohail F., Bangash R.L., Azim W., Arshad F, Anwar A., Niazi K.A. Analgesia for the Change of Dressing in Burn Victims: A Comparison between Oral Ketamine and Oral Dexmedetomidine. Esulapio 2021;17(01):39-44

A Prospective, Randomized, Double-blinded Control Study on Comparison of Oral Midazolam and Dexmedetomidine as Premedication in Children

A Prospective, Randomized, Double-blinded Control Study on Comparison of Oral Midazolam and Dexmedetomidine as Premedication in Children

Two oral sedation regimens in pediatric dentistry: a randomized controlled trial

Objectives: Dental procedures are always associated with some degree of anxiety, and children are usually more prone to it. General anesthesia may have to be used in more complex procedures, but many dental procedures can successfully be undertaken with therapeutic sedation. The aim of this trial was to evaluate the effectiveness of oral sedation using dexmedetomidine in comparison with ketamine in the management of uncooperative pediatric patients during dental treatment.&#x0D; Methodology: A randomized clinical trial was carried out on 40 ASA physical status-I children aged 2-6 y to investigate the effect of using dexmedetomidine and ketamine with atropine for sedation.&#x0D; The children were equally and randomly divided into two groups: Group K: received oral ketamine 5 mg/kg with atropine 0.01 mg/kg, and Group D: received oral dexmedetomidine 3 µg/kg. Recovery time, vital signs, and side effects were all recorded. Behavior rating was also assessed using the Ohio State University Behavioral Rating Scale (OSUBRS).&#x0D; Results: The children in Group D were more sedated than in Group K, but the difference was not statistically significant (p = 0.22). The median recovery time was significantly shorter in Group D than in Group K (p = 0.003). No adverse effects, episodes of respiratory or cardiovascular instability were noted in either groups.&#x0D; Conclusions: Oral dexmedetomidine is equally effective to oral ketamine for sedation in children undergoing outpatient dental procedures, but has relatively a shorter recovery time.&#x0D; Citation: Hammadyeh A, Altinawi M, Rostom F. Two oral sedation regimens in pediatric dentistry: a randomized controlled trial. Anaesth pain &amp; intensive care 2019;23(4)__

Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.

Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. To explore the effectiveness of IND for procedural distress in children. We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. We included randomized trials of IND for procedures in children. Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. Among 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures. The adequacy of sedation was subjective, which possibly led to biased outcome reporting. Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.

A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

Effect of premedication with clonidine, midazolam, and dexmedetomidine on stress response and sedation in pediatric congenital cardiac surgeries

Background Children undergoing cardiac surgery experience a substantial stress response mediated by the release of stress hormones and cytokines. Providing sedation and blunting stress response by one drug in a single oral dose and excellent oral bioavailability of clonidine prompted us to study its efficacy as premedication in pediatric patients and compare it with both oral midazolam, a gold standard premedication in pediatric patient, and oral dexmedetomidine, as a newer α2 receptor agonist. Aim To compare the effect of premedication with three drugs (clonidine, midazolam and dexmedetomidine) in pediatric congenital cardiac surgeries including their effect on the stress response during surgery. Patients and methods Patients were categorized into three groups (30 patients each): group clonidine (C) received oral clonidine at a dose of 4 µg/kg, group midazolam (M) received oral midazolam at a dose of 0.5 mg/kg, whereas group dexmedetomidine (Dx) received oral dexmedetomidine at a dose of 1 μg/kg. All the drugs were mixed with equal volume of 5% dextrose. Results The bispectral index measurements in group Dx became significantly lower at 15 min and 30 min compared with the other two groups. Then, significantly lower bispectral index measurements were observed in group C compared with groups M and Dx at 45 min and afterward. The serum cortisol and catecholamines levels in group C became significantly lower than that in groups M and Dx after intravenous cannulation, after sternotomy, and at the end of surgery. Conclusion Clonidine, as a preanesthetic drug in congenital heart surgery, is effective in decreasing stress response and achieving adequate level of sedation till the end of surgery. Oral dexmedetomidine has faster onset compared with midazolam in reaching the adequate level of sedation.

A comparison of oral dexmedetomidine and oral midazolam as premedicants in children.

Background and Aim:Midazolam has been the most popular oral premedicant in children despite its side effects. Dexmedetomidine with its favorable clinical profile is a suitable alternative, but with limited research. The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam as oral premedicants in children.Material and Methods:Eighty children of the American Society of Anesthesiologist physical status I scheduled for elective herniotomy were included in this prospective randomized double-blind study. Patients were randomly assigned to receive either dexmedetomidine 4 μg/kg (Group A, n = 40) or midazolam 0.5 mg/kg (Group B, n = 40) orally 40 min before induction. Pre-operative sedation, response to parental separation and venepuncture, emergence agitation, recovery nurse satisfaction, and side effects were compared between the two groups. Quantitative data were compared using unpaired Student's t-test and categorical variables with Chi-square test.Results:Pre-operative sedation and response to parental separation and venepuncture were similar between the two groups. Group A had a significantly lower incidence and severity of emergence agitation (P = 0.000). Recovery nurse satisfaction was significantly higher in Group A (P = 0.002). However, incidence of hypotension and bradycardia was found to be more in Group A (P = 0.04).Conclusion:Premedication with oral dexmedetomidine is as effective as oral midazolam in providing sedation and anxiolysis in children. Dexmedetomidine in addition reduces the incidence and severity of emergence agitation.

Comparison of Oral Dexmedetomidine Vs Oral Midazolam as Pre-Medication for Children Undergoing Elective Surgical Procedures

Comparison of Oral Dexmedetomidine Vs Oral Midazolam as Pre-Medication for Children Undergoing Elective Surgical Procedures

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children.

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children.

Comparison of Oral Clonidine, Oral Dexmedetomidine, and Oral Midazolam for Premedication in Pediatric Patients Undergoing Elective Surgery.

Background:Midazolam has been commonly used orally for premedication in children. A search for a better alternative continues to overcome its side effects. Recently alpha-2 agonists, clonidine, and dexmedetomidine have been used for premedication in children.Aim:To study and compare the efficacy of oral clonidine, oral dexmedetomidine, and oral midazolam for premedication in pediatric surgical patients.Settings and Design:This prospective, randomized, double blind study was conducted in a tertiary care hospital.Materials and Methods:The study was conducted in ninety children of either sex, in the age group of 4–12 years and the American Society of Anesthesiologists Physical status I, posted for ophthalmic surgery. Patients were randomly allocated to one of the three groups of thirty patients each: Group M: Oral midazolam 0.5 mg/kg body weight, Group D: Oral dexmedetomidine 4 μg/kg body weight, and Group C: Oral clonidine 4 μg/kg body weight. Patients were assessed for sedation, anxiolysis, and change in heart rate and blood pressure in the preoperative area. Behavior of children at separation from parents, mask acceptance, and side effects if any were noted.Statistical Analysis:Data analysis was performed by unpaired Student's t-test and Chi-square test.Results:Children in oral midazolam group achieved faster onset of sedation, higher sedation score, and lower anxiety score as compared to other two groups. The Group D and Group M were comparable as regards behavior at separation from parents (P = 0.236), but Group D was significantly better than Group C (P = 0.031). The three groups were comparable as regards providing satisfactory mask acceptance (P = 0.163). A number of children with easy separation from parents and excellent mask acceptance were significantly more in Group M as compared to Groups C and D (P = 0.028 and P = 0.012, respectively). Group C and Group D showed a lower mean arterial pressure at 45 min (P < 0.001) and 60 min after premedication (P < 0.001) as compared to Group M.Conclusion:Oral midazolam is superior to the oral clonidine, and oral dexmedetomidine with faster onset of sedation, higher sedation score, lower anxiety score, and greater number of children with easy separation and excellent mask acceptance.

Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients.

Background and Aims:Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA.Methods:Prospective double-blinded study involving ninety patients aged 1–10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time. Incidence and severity of EA, post-operative pain and requirement of rescue analgesic were assessed at 0, 5, 15, 30 and 60 min postoperatively.Results:Data were analysed applying Student's t-test and Chi-square test using SPSS software. Mask acceptance was better in Group B (97.8% vs. 73.4%, P < 0.001). Mean arterial pressure was lower in Group B (P < 0.001) though clinically not significant. More rescue analgesic was required in Group A (5.6% vs. 0%). There was no significant difference in adverse effects. Although there was a higher incidence of EA in Group A (Aono's score 3 and 4; 40% vs. 4.4%), none of them required intervention (paediatric anaesthesia emergence delirium score >10; 0 vs. 0).Conclusion:Premedication with oral dexmedetomidine provides smooth induction and recovery, reduces the EA and provides better analgesia and sedation as compared to oral midazolam.