Premedication In Pediatric Patients Research Articles

Comparison of hemodynamics changes after infusion of Dexmedetomidine versus Midazolam as a premedication in pediatric patients undergoing lower abdominal surgery

Comparison of hemodynamics changes after infusion of Dexmedetomidine versus Midazolam as a premedication in pediatric patients undergoing lower abdominal surgery

Efficacy and safety of oral versus intranasal midazolam as premedication in children: a systematic review and meta-analysis.

Midazolam hydrochloride is a widely accepted benzodiazepine for premedication in pediatric patients. However, there is no consistent conclusion regarding which route of administration is best. We performed a meta-analysis to assess the efficacy and safety of oral versus intranasal midazolam premedication in children. The PubMed, Embase, Cochrane Library, and Google Scholar databases were searched from inception to June 2022, for randomized controlled trials comparing oral versus intranasal midazolam. Primary outcomes included satisfactory mask acceptance for induction and satisfactory sedation at separation from parents. Secondary outcomes included the incidence of postoperative nausea and vomiting, incidence of nasal irritation, postoperative recovery time, and hemodynamic changes. Data from 14 studies involving a total of 901 children were obtained. The results indicated that intranasal and oral midazolam premedication in children provided similar satisfactory mask acceptance for induction (RR, 1.02; 95% CI, 0.93-1.13; P=0.64; I2=0%), satisfactory sedation at separation from parents (RR, 0.99; 95% CI, 0.89-1.10; P=0.90; I2=57%), and postoperative recovery time (WMD, -8.01; 95% CI, -20.16-4.14; P=0.20; I2=85%). Additionally, intranasal midazolam premedication was associated with lower incidence of postoperative nausea and vomiting (RR, 0.70; 95% CI, 0.51-0.96; P=0.03; I2=0%) and shorter onset time. Differences between intranasal and oral midazolam in satisfactory mask acceptance for induction, satisfactory sedation at separation from parents, and postoperative recovery time were not significant. Intranasal midazolam premedication was associated with shorter onset time and higher incidence of nasal irritation.

Comparison of intranasal midazolam-fentanyl with dexmedetomidine–fentanyl as pre-medication in the paediatric age group

Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 μg/kg) and group B received intranasal dexmedetomidine (1 μg/kg)-fentanyl (2 μg/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher's Facial Pain Scale. Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher's Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine-fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

BackgroundIntranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. We conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients.MethodsWe searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study.ResultsA total of 16 studies with 1066 patients were enrolled. Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure (SMD = -0.53, with 95% CI [-0.93, -0.13]) and heart rate (HR) (SMD = -1.39, with 95% CI [-2.84, 0.06]). Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level (61.76% vs 40.74%, RR = 1.53, with 95%CI [1.28, 1.83]), more rapid onset of sedation (SMD = -0.59, with 95%CI [-0.90, -0.28]) and more rapid recovery (SMD = -1.06, with 95%CI [-1.83, -0.28]). Current evidences also indicated that the differences of various adverse effects between two groups were not significant.ConclusionsGiven that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future.Trial registrationThe protocol of present study was registered with PROSPERO (CRD42022321348).

Efficacy of premedication with intravenous midazolam on preoperative anxiety and mask compliance in pediatric patients: a randomized controlled trial.

To alleviate anxiety before surgery is a significant concern for the pediatric anesthesiologist. Midazolam has been generally used as a premedication, and compelling data regarding effective dose to mitigate anxiety is lacking. The current trial addressed the comparable efficacy of intravenous midazolam with different doses regarding the anxiety state, ease of child-parental separation, and mask compliance as premedication in pediatric patients undergoing tonsillectomy. Three hundred and twelve children aged 2-8 years were randomly assigned, 104 per group, to receive intravenous 0.03 mg/kg midazolam (group A), 0.05 mg/kg midazolam (group B), or saline control (group C), 40 minutes before surgery. We assessed the anxiety state every 10 min after premedication with modified Yale preoperative anxiety scale (mYPAS), evaluated the emotional state during separation with parental separation anxiety scale (PSAS), and compared their compliance to mask oxygen supply with mask acceptance score (MAS). Children premedicated with 0.05 mg/kg midazolam achieved a sedated state more rapidly than those who received 0.03 mg/kg midazolam (5.9±2.3 vs. 7.0±3.9, P=0.02). The proportion of satisfactory parental separation and compliance to mask ventilation was not different between midazolam groups, which was superior to saline control. The children receiving 0.05 mg/kg midazolam stayed longer in postoperative care unit than those receiving 0.03 mg/kg midazolam and saline. The incidence of postoperative adverse events was rare and comparable among groups. Intravenous administration of a single dose of midazolam 0.05 and 0.03 mg/kg produces similar effects on sedation status, parental separation, and mask induction acceptance, except for rapid-onset and long sedation duration in pediatric patients premedicated with 0.05 mg/kg midazolam. ClinicalTrials.gov NCT04266340.

Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials.

To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. PROSPERO (CRD42021262516); registered 22 July 2021.

Comparison of intranasal dexmedetomidine and oral midazolam as premedication for cochlear implant surgery in children

Background: Children undergoing surgical procedures can experience significant anxiety and distress during the perioperative period. The use of sedative premedication may help to reduce anxiety, minimize the emotional trauma, and facilitate a smooth induction of anesthesia. Midazolam is most commonly used as a premedication agent in children. Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist that provides sedation, anxiolysis, and analgesic effects without causing respiratory depression. Aims and Objectives: The aim of the study was to compare intranasally administered dexmedetomidine and oral midazolam for premedication in pediatric patients undergoing cochlear implant surgeries. Materials and Methods: This prospective randomized controlled study included 60 ASA Grade I and II patients between 1 and 6 years of age who underwent cochlear implant surgeries under general anesthesia. Patients were divided into two groups. Group A received 1μg/kg intranasal dexmedetomidine and Group B patients received 0.5 mg/kg oral midazolam 45 min before induction. The pediatric separation anxiety was assessed using the pediatric separation anxiety scale (PSAS) while shifting the patient to operating room (OR) and mask acceptance was assessed by the attending anesthesiologist using mask acceptance scale (MAS) in OR who is blinded to the drug given. Heart rate (HR) and oxygen saturation were monitored till the end of procedure was noted on a pre-structured proforma. Results: The mean PSAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.10±0.31 (P=0.000). The mean MAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.13±0.35 (P=0.000). Mean HR (P>0.05), systolic blood pressure (P>0.05), and diastolic blood pressure (P>0.05) were comparable between both the groups. There was a statistically significant association seen between sedation grade and the groups (P=0.000), showing that groups are dependent on the sedation group. There was a statistically significant association seen between wake up behavior grade and the groups (P=0.000), showing that groups are dependent on the wake up behavior grade. Conclusion: Intranasal dexmedetomidine is an effective and safe alternative for premedication in view of parental separation, mask acceptance, hemodynamic stability, and sedation for the children undergoing cochlear implant surgeries under general anesthesia.

Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial.

BackgroundAllaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia.Methods Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study's primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events.ResultsThe median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

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 < 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.

Comparison of intranasal and nebulized dexmedetomidine for premedication in pediatric patients: A non-inferiority randomized controlled trial.

Dexmedetomidine is a highly selective α-2 adrenoreceptor agonist and has been found to be an effective premedication agent when administered via the intranasal route. We aimed to compare the efficacy of dexmedetomidine premedication administered via intranasal route and through nebulization in pediatric patients. This non-inferiority randomized controlled trial was conducted after getting approval from institutes ethics committee and informed written parental consent. Sixty-four children aged 2-8 years scheduled for elective surgery under general anesthesia were enrolled and were divided into two groups. Group I (Intranasal, n = 33) received 2 mcg/kg dexmedetomidine via intranasal route and group N (Nebulized, n = 31) received 2 mcg/kg dexmedetomidine through nebulization. The primary outcome was number of patients with satisfactory sedation 30 minutes after premedication at separation from parent. The secondary outcome included ease of medication acceptance, anxiety at parental separation, acceptance of anesthesia mask, perioperative hemodynamics, emergence agitation during recovery and adverse effects. Data collected was analyzed using Chi-square test, Student "t" test and Mann-Whitney U test with the help of SPSS 22. A one tailed P value < 0.025 was considered significant. Demographic profile was comparable between groups. On arrival in OR 27 (81.8%) patients in group I and 21 (67.7%) patients in group N had satisfactory sedation score (P = 0.19). The median (IQR) sedation score was comparable between group I and group N (P = 0.057). Patients in Group I showed significantly better medication and mask acceptance scores (P < 0.0001, P = 0.001 respectively), parental separation anxiety score (P < 0.0001) and emergence agitation score (P = 0.001). There were no significant differences in hemodynamic parameters and adverse effects between the groups. Although nebulized dexmedetomidine is non-inferior to intranasal dexmedetomidine in providing desired level of sedation but intranasal administration had better acceptance of medication and anesthesia mask with lesser anxiety at parental separation and postoperative emergence agitation.

Intranasal midazolam versus intranasal dexmedetomidine as premedication in paediatric patients: A comparative study

: Preanesthetic medication is important among the paediatric patients undergoing surgeries. A good preanesthetic medication reduces the anxiety and the post-operative pain among paediatric patients. A randomised controlled trial was done to compare the two groups of Dexmedetomidine, and Midazolam given as preanesthetic medication intranasally.: Both the groups had comparable baseline values before premedication but there was a significant difference in the vital parameters of heart rate and systolic blood pressure after medication. The mean Parental Separation Anxiety Scale was found to be 1.4 ± 0.85 and 2.5 ± 0.98 among Dexmedetomidine and Midazolam group respectively. This was found to be significant (p &amp;#60; 0.001). Dexmedetomidine when given as preanesthetic medication intranasally significantly controls the vitals within the normal range and produces better parental separation anxiety scores and mask acceptance scores as compared to Midazolam.

Comparative evaluation of nebulized ketamine and its combination with dexmedetomidine as premedication for paediatric patients undergoing surgeries under general anaesthesia

BackgroundVarious drugs have been endorsed but no standardised premedication protocol exists for paediatric patients. Nebulised form of drug not only results in better patient acceptability but also has improved clinical effectiveness. The present study delineates and evaluates the efficacy and safety of nebulised ketamine and combination of nebulised dexmedetomidine and ketamine for premedication in paediatric patients. MethodsProspective randomised controlled study was planned in patients, 3–10 years of age, undergoing surgeries. Patients received either nebulised ketamine (2 mg/kg) (group X, n = 23) or dexmedetomidine 1 μg/kg plus ketamine (1 mg/kg) (group Y; n = 24), 30 min before shifting inside the operation theatre. The sedation level, haemodynamic response and ill-effects were recorded for 30 min. ResultsThe baseline haemodynamic (HR, MAP, RR and SpO2) parameters were normal and comparable in both the groups. There was no significant variation noticed in terms of HR, MAP, RR and SpO2% in either of the groups at 15 min (p < 0.15, p < 0.20, p < 0.85, p < 0.46) and 30 min (p < 0.21, p < 0.97, p < 0.75, p < 0.61) respectively, after receiving premedication. The level of sedation in group Y (score of 4 or less) was found to be better than that achieved by group X patients (p < 0.001). Face mask acceptance was satisfactory in group Y (score of 2 or less) as compared to group X patients (p < 0.001). The parental separation was comparable in both groups (p = 0.46). ConclusionNebulisation is a satisfactory method of premedication for children. A combination of nebulised ketamine with a dose of 1 mg/kg and dexmedetomidine with a dose of 1 μg/kg is capable of producing a satisfactory level of sedation in a more effective manner than sedation induced by nebulised ketamine alone (2 mg/kg).

Intranasal dexmedetomidine vs intranasal midazolam for premedication in paediatric patients undergoing surgery under general anaesthesia

Introduction: This prospective, randomized, double-blind study was conducted with an aim to compare the efficacy of intranasal dexmedetomidine and intranasal midazolam as premedication in uncooperative children undergoing elective surgery under general anaesthesia. Materials and Methods: One hundred and twenty children in American Society of Anesthesiology classification (ASA) physical status I & II, in the age group of 2-12 years who were planned to undergo surgery under general anaesthesia, were included in the study and were randomly assigned to one of the two groups. Group D received 1 mcg/kg of IN dexmedetomidine while group M received 0.2 mcg/kg of IN midazolam for premedication. The patient’s sedation status, separation anxiety and mask acceptance along with the hemodynamic parameters were noted. Results: Satisfactory sedation was achieved in 56% children in group M and 65% children in group D (p > 0.05). Compared with the children in group M, those in group D had significantly better satisfactory anxiolysis at the time of separation from the parents (56 vs 50; p Conclusion: Intranasal midazolam and dexmedetomidine are both effective as premedication in children undergoing surgery. However, intranasal dexmedetomidine offers better effect on sedation, alleviating separation anxiety and acceptance of facemask during induction than intranasal midazolam. Keywords: Intranasal, Dexmedetomidine, Midazolam.

Intranasal midazolam versus intranasal ketamine as premedication in paediatric patients: A comparative study

This study aims to compare the efficacy of intranasal midazolam and ketamine as premedication before anaesthesia in paediatric patients.Sixty pediatric patients scheduled for surgery between the age group of 2-8 years and belonging to the American Society of Anesthesiologists (ASA) grade I and II were selected for the study. Group A received midazolam (0.2 mg/kg) and Group B received ketamine (5 mg/kg), intranasally 30 minutes before surgery with monitored anesthesia care. Sedation score, parenteral separation reaction, intravenous cannula acceptance, mask acceptance, and hemodynamic parameters were measured.Patients of both the groups were calm and tranquil, but sedation scores were higher in the ketamine group (3.37±0.67) in comparison to midazolam group (2.60±0.67) at 30 minutes. Parenteral separation was easier in ketamine group compared to midazolam group with a significantly higher separation reaction scores (p&amp;#60;0.05). Venous cannulation and face mask acceptance was also better in the ketamine group with a significantly higher percentage of patients with satisfactory venous cannulation and face mask acceptance (p&amp;#60;0.05). Non-invasive blood pressure, oxygen saturation, and respiratory rate were maintained in both the groups throughout the study period, however tachycardia was observed in the ketamine group.Administration of the drug through the nasal route is an effective way for paediatric premedication. Both midazolam and ketamine gave a good level of sedation, however, level of sedation, venipuncture acceptance, and face mask acceptance were significantly better in the ketamine group. No adverse effects of the premedication drugs were observed in any of the groups.

Randomised Comparison between the Efficacy of Two Doses of Nebulised Dexmedetomidine for Premedication in Paediatric Patients.

ObjectiveNebulised dexmedetomidine can be an easy alternative for preoperative sedation in paediatric patients, but data regarding its efficacy are very limited.MethodsThis prospective, randomised, double-blind study included 66 patients aged between 1 and 8 years. Patients were divided into two groups as D2 and D3. The D2 group received 2 μg kg−1 of nebulised dexmedetomidine, and the D3 group received 3 μg kg−1 of nebulised dexmedetomidine preoperatively. All the patients received general anaesthesia and caudal epidural analgesia with 0.75 mL kg−1 of 0.2% ropivacaine. Parental Separation Anxiety Scale at 30 min after the end of nebulisation, Mask Acceptance Score (MAS) during induction, haemodynamic variables, emergence agitation and duration of caudal analgesia were compared between the groups. Statistical analysis was done using Mann-Whitney U test and chi-square test. A p-value <0.05 was accepted as significant.ResultsAll the parameters were comparable between the D2 and D3 groups; however, significantly more number of younger children was observed in the D3 group. Hence, further analysis was done after division into the lower age (1–3 years) and higher age (4–8 years) groups. In lower age group children, satisfactory parental separation was achieved in 100% of the patients in the D3 group compared to 20% of those in the D2 group (p=0.00). MAS was significantly better in the D3 group in both the lower (p=0.019) and higher (p=0.036) age groups.ConclusionWe conclude that nebulised dexmedetomidine in a dose of 3 μg kg−1 provides better parental separation and mask acceptance in younger children.

A comparison of intranasal ketamine, intranasal dexmedetomidine, and their combination as premedication in pediatric patients undergoing cardiac catheterization

Background Minimizing preoperative anxiety and facilitating parental separation may be of particular importance in pediatric patients undergoing cardiac catheterization. This prospective randomized study was conducted to compare intranasal ketamine, intranasal dexmedetomidine, and their combination as sedative premedications in pediatric patients undergoing cardiac catheterization. Patients and methods Ninety pediatric patients aged between 2 and 4 years scheduled for interventional cardiac catheterization under general anesthesia were included in the study and were randomized to receive intranasal ketamine 5 mg/kg, intranasal dexmedetomidine 2 µg/kg, or a combination of intranasal dexmedetomidine 1 µg/kg plus ketamine 3 mg/kg. The primary outcome of the study was children’s behavior during venous cannulation. The secondary outcomes were onset of sedation, behavior at parental separation, propofol consumption during the procedure, recovery time, incidence of postoperative agitation, and other adverse events. Results The number of patients who had satisfactory venipuncture score was significantly higher in group K (83.3%) and group DK (82.7%) than in group D (55.1%). The onset of sedation was significantly faster in group K (8.37±2.8 min) and group DK (16.7±5.9 min) than in group D (26.8±7.6 min). The number of patients who had satisfactory parental separation was comparable among the studied groups. The incidence of emergence agitation and excessive salivation were significantly higher in group K compared with group D and group DK; meanwhile, the incidence of bradycardia was significantly higher in group D compared with group K and group DK. Conclusion Using a combination of intranasal ketamine and dexmedetomidine was associated with significantly more satisfactory venous cannulation conditions and faster onset of sedation than using intranasal dexmedetomidine alone. The combination was also associated with less adverse events than using either drug alone.

Comparison of medication acceptance of intranasal midazolam administered by parents versus doctors in children - A randomized trial.

BACKGROUND:The positive effects of midazolam as a premedication in pediatric patients are well documented. Although there are many studies regarding the route and dosage of administration, literature does not have any evidence on the outcome of medication acceptance based on the person administering the drug.AIM:The aim of this study was to compare the medication acceptance and preoperative anxiolysis of intranasal midazolam administered by parents and anesthesiologists.MATERIALS AND METHODS:This prospective randomized study was conducted in sixty children belonging to the American Society of Anesthesiologists Class 1 or 2 belonging to either sex, aged between 1 and 9 years, undergoing elective surgeries. Group P received intranasal midazolam administered by parents, whereas Group D received intranasal midazolam administered by doctors. Various scores were assessed.RESULTS:Children were more sedated in Group P. Clinically, medication acceptance was better in Group P when compared with Group D, but a statistically significant difference in medication acceptance was seen only in patients who are >4 years of age. Parental separation, Ramsay Sedation Score, and mask acceptance were better in Group P than in Group D.CONCLUSION:Intranasal midazolam when given by parents produces better preoperative anxiolysis and easier parental separation as compared with administration by a medical staff.

Comparison of the use of nebulized dexmedetomidine, ketamine, and a mixture thereof as premedication in pediatric patients undergoing tonsillectomy: a double-blind randomized study

Purpose To compare the use of nebulized dexmedetomidine, nebulized ketamine, and a mixture thereof as premedication in children aged 3–6 years undergoing tonsillectomy. Patients and methods Seventy-five patients were assigned randomly to three groups (n=25/group) that received nebulized dexmedetomidine (3 μg/kg; group A), nebulized ketamine (3 mg/kg; group B), and nebulized dexmedetomidine (1.5 μg/kg) plus nebulized ketamine (1.5 mg/kg; group C). The drugs were prepared in 0.9% normal saline, and the children underwent nebulizer sessions 30 min before surgery. The primary end point was the level of sedation, measured 30 min after nebulization using Ramsay scale. We also measured ease of parental separation, face mask acceptance, hemodynamic stability, postoperative analgesia requirement (using a visual analog scale), and recovery and discharge times. Results The three groups did not differ in terms of age, sex, or weight. The level of sedation (in 15 and 30 min) was higher in group A than in group B (P=0.039), but no significant difference in sedation score was detected among the three groups. Ease of parental separation and face mask acceptance were better in group A than in group B (P=0.037). The groups did not differ in terms of analgesia requirement, recovery time, or discharge time. Conclusion Nebulized dexmedetomidine achieves better sedation and facilitates parental separation and face mask acceptance during inhalational induction compared with nebulized ketamine and a mixture of nebulized ketamine and dexmedetomidine, with no effect on hemodynamic stability or recovery or discharge time.

Comparison of Sublingual and Nasal Applications of Dexmedetomidine Premedication in Pediatric Patients

Comparison of Sublingual and Nasal Applications of Dexmedetomidine Premedication in Pediatric Patients

Combination With Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Patients

Combination With Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Patients