Premedication In Pediatric Patients Research Articles

Comparative Study of Oral Clonidine and Midazolam as Premedication in Pediatric Patients Undergoing Tonsillectomy

Background and Aim: Anxiety and fear of operation, injections, physicians, operation theatre environment and parental separation are all traumatizing experiences in children. The aim of the study was to compare the effects of oral midazolam and oral clonidine as premedication in children undergoing tonsillectomy .The preoperative sedation, anxiolytic, acceptance of mask for induction of anaesthesia, intravenous cannulation and post-operative recoverywere assessed in both groups. Methods: Aprospective randomized double blinded study of 100 patients of age group 4 -12 yrs undergoing tonsillectomy under general anaesthesia were selected. They were divided into 2 groups of 50 patients each. Group A (oral clonidine) received 4 mcg/kg 90 minutes before induction. Group B (oral midazolam) received 0.5 mg/kg 90 minutes before induction. The sedation and anxiety score was noted at the time of parental separation. The reaction to IV cannulation was assessed by sedation and anxiety scoring at the same time all of them were taken under GA with controlled ventilation. The Mask acceptance was graded by 5 point scoring system .Grade 3,4 and 5 are satisfactory.They were monitored throughout the surgery for any complications. Post operative status was assessed by Modified Objective Pain score. Results: The sedation score and anxiety score at venipuncture was better with clonidine group with statistical significance (p< 0.000 and<0.003). The mask acceptance was better with clonidine group with statistical significance (p <0.000).Postoperative score was also better with clonidine group with statistical significance of p value <0.000. Conclusion: We concluded that oral clonidine and midazolam can be used as better premedicants to produce optimal sedation and emotional state.Clonidine 4 μg / kg has been shown to be a more effective premedication for children undergoing elective tonsillectomy than midazolam 0.5mg/kg

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.

Comparative Study of Intranasal Dexmedetomidine v/s Midazolam as a Premedication in Pediatric Patients Undergoing Cardiac Surgery

Comparative Study of Intranasal Dexmedetomidine v/s Midazolam as a Premedication in Pediatric Patients Undergoing Cardiac Surgery

Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia

TitleComparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.BackgroundMany techniques and drug regimens, with partial or greater success, have been tried from time to time to eliminate the anxiety component and to prolong the postoperative analgesia during regional anesthesia. In pediatric patients, anxiety and lack of cooperativeness for the regional procedure is the major problem in providing spinal anaesthesia. Alpha2-adrenergic agonists have both analgesic and sedative properties, when used as an adjuvant to regional anesthesia. They eliminate the anxiety, provide conscious sedation, lower the level of agitation and improve patient satisfaction. We designed a prospective, randomized, double-blind study, to evaluate and compare the efficacy of intravenous dexmedetomidine with clonidine as a premedication drug during spinal anaesthesia using intrathecal bupivacaine.Materials and methodsIn this prospective, randomized, double-blind study, 60 pediatric patients 4–10 years of age of the American Society of Anesthesiologists status I, scheduled for uro-genital surgery under spinal anesthesia, were randomly allocated into two groups of 30 each. Group DE received dexmedetomidine 1 μg kg−1 and group CL received clonidine 1 μg kg−1 diluted in 20 ml of normal saline intravenously over 10 min, 40 min before subarachnoid anaesthesia with 0.5% hyperbaric bupivacaine. The patients were monitored every 5 min for 1st 20 min and then every 10 min interval vitals were noted. Acceptable sedation score, parental separation anxiety level and degree of mask acceptance were assessed. Highest level of sensory blockade, time of two segment regression and time of first request of analgesic were also noted. Data was analyzed using Fisher’s exact test or Chi-square test and the value of P < 0.05 was considered statistically significant.ResultsGroup DE and CL had comparable sedation score (p > 0.05). However, parental separation anxiety score and mask acceptance score, were better in DE than CL group (p < 0.05). There was no significant haemodynamic differences between the groups (p > 0.05). Duration of analgesia was also prolonged in DE group.ConclusionDexmedetomidine is superior to clonidine as a premedication drug in pediatric patients undergoing spinal anesthesia.

Oral gabapentin premedication for post-tonsillectomy nausea, vomiting, and recovery

Background Gabapentin is a second-generation anticonvulsant that is successful in the management of chronic neuropathic pain. It was not previously known to be useful in acute perioperative conditions, but recently it has been used for acute perioperative conditions. However, evidence-based medicine suggests that perioperative administration is useful for postoperative analgesia, preoperative anxiolysis, attenuation of the hemodynamic response to laryngoscopy and intubation, and preventing chronic postsurgical pain, postoperative nausea and vomiting (PONV), and delirium. This article reviews the clinical trial data to describe the efficacy and safety of gabapentin for perioperative anesthetic management. Aim The aim of the study was to evaluate and update the effect of preoperative gabapentin on the incidence of postoperative vomiting and on analgesic requirements after adenotonsillectomy in pediatrics. Materials and methods This randomized, double-blind study was designed to explore the possible effects of oral gabapentin as a premedication on the incidence and severity of PONV and on the early recovery profile of pediatric patients undergoing adenotonsillectomy under sevoflurane anesthesia. Results The incidence of PONV in the gabapentin group was significantly lower than in the gabapentin group. However, the numbers of rescue ondansetron doses and the PONV severity score were comparable in the two groups. Conclusion The use of gabapentin as premedication in pediatric patients undergoing adenotonsillectomies under sevoflurane anesthesia reduces the incidence of PONV and emergence agitation in the early postoperative period. However, gabapentin did not reduce pain and analgesic consumption after surgery.

Intranasal Fentanyl, Midazolam and Dexmedetomidine as Premedication in Pediatric Patients.

Background:Surgery is a very stressful experience for patients. Children are the most susceptible to fear, anxiety, and stress due to their limited cognitive capabilities and dependency. In children, pharmacologic agents are frequently used as premedication to relieve the fear of surgery, to make child–parental separation easy, and to carry out a smooth induction of anesthesia. We conducted this study to compare the efficacy of intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients.Materials and Methods:The present study was conducted prospectively on 75 patients in the age group of 2–6 years of either sex of the American Society of Anesthesiologists physical Class I or II admitted in Guru Nanak Dev Hospital, attached to Government Medical College Amritsar, scheduled to undergo surgery under general anesthesia. The patients were divided into three groups of 25 each. Group F received intranasal fentanyl 1.5 μg/kg body weight, Group M received intranasal midazolam 0.3 mg/kg body weight, and Group D received intranasal dexmedetomidine 1 μg/kg body weight as nasal drops 50 min before surgery.Results:Children who received intranasal fentanyl and intranasal midazolam had early onset of anxiolysis and sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedicant. Postoperative sedation was better with dexmedetomidine as compared to fentanyl and midazolam.Conclusion:Onset of action of fentanyl and midazolam is early as compared to that of dexmedetomidine. However, fentanyl provided better conditions for induction and emergence than midazolam. With dexmedetomidine onset of action was delayed and duration of action was prolonged which helped child to remain calm and sedated even after the surgery.

Oral Midazolam as a Pre-Medication in Paediatric Patients

Introduction: In some medical circumstances, pediatric patients may need premedication for transferring to the operating room. In these situations, using oral premedication is preferred. We assessed the efficacy and safety of oral midazolam to reduce the anxiety and improve behavior in children undergoing general anesthesia. Method: In a double-blind randomized clinical trial, 90 children aged between 1-8 years were assigned to one of three oral premedication groups by random selection. Each group contained 30 children. Group I received 0.5 mg/kg oral midazolam Group II received 0.75 mg/kg oral midazolam both in 25% dextrose to a total volume of 5 ml. Group III or control group received 5 ml of 25% dextrose. To study its acceptility, onset and level of sedation, changes in vitals like pulse rate, blood pressure and emotional state before and after sedation, and post-op side effects. Disscussion: After premedication, difference in pulse rate, systolic blood pressure and respiratory rate between the three groups was not statistically significant sedation at 30 minutes after premedication was better in study group II as compared to study group I Emotional state was concluded to be better in study Group II (0.75 mg/ kg) as compared to study group I (0.5 mg/kg) at the time of separation from parents. More post operative complications like nausea, vomiting, giddiness, headache with a dose of 0.75 mg/kg than with a dose of 0.5 mg/kg. Conclusion: So we conclude that oral midazolam in a dose of 0.5 mg/kg for premedication in pediatric patients at it provides good to excellent sedation at 30 minutes at the time of separation from parents, with better quality of separation, and stable emotional state at induction without significant hemodynamic changes with less postoperative

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.

Pre anaesthetic medication in children: A comparison of intranasal dexmedetomidine versus intranasal midazolam

Background &amp; objectives: Children are more anxious and fearful due to their limited cognitive capabilities, lack of understanding of health care system and lack of self control. It becomes an important concern for an anaesthesiologist to relieve their pre-operative anxiety. Midazolam is frequently used as premedication agent in children. New drugs such as the alpha-2 agonists have also been introduced as alternatives for premedication in pediatric patients. The present study was planned to compare intranasal Dexmedetomidine with intranasal Midazolam as a preanaesthetic medication in children with the primary objectives of assessing preoperative sedation &amp; ease of child parent separation and secondary objectives of assessing analgesia in the postoperative period. Materials and methods: Seventy children, aged between 2-6 years of either sex,belonging to ASA Grade I &amp; II and weighing between 10-16kg were enrolled in this prospective,single blinded, randomized and comparative clinical study. The children were divided into two groups of 35 each. Forty five minutes before induction, Group-D(n=35)-received intranasal Dexmedetomidine 1mcg/kg and Group M(n=35) –received intranasal midazolam 0.3mg/kg. Results: Children who were premedicated with intranasal dexmedetomidine had lower sedation (MOAA/S Scale) scores (P&lt;0.0001), and easier child-parent separation than children who received intranasal midazolam. Postoperatively, less number of patients required rescue analgesia in the dexmedetomidine group. Conclusion: Intranasal Dexmedetomidine can be used effectively and safely as a preanaesthetic medication in children undergoing minor surgical procedures under General anaesthesia.

A comparative study between midazolam, promethazine, and chloral hydrate as oral premedication in pediatric patients

Background Ensuring adequate preoperative sedation and anxiolysis is essential, especially in pediatric surgery. Various drugs and routes of administration have been evaluated to determine the optimal method of sedation. Aim The aim of the study was to compare the clinical effects of orally administered midazolam, promethazine, and chloral hydrate as premedication in pediatric patients. Patients and methods Ninety children of both sexes, of ASA grade I-II, aged 3-6 years, scheduled to undergo pediatric surgery were allocated randomly into three groups of 30 patients each. Group M (midazolam) patients were premedicated with a dose of 0.5 mg/kg of injectable midazolam mixed in sugar-free apple juice. Group P (promethazine) patients were premedicated with 1 mg/kg of the commercially available syrup. Group CH (chloral hydrate) patients were premedicated with 50 mg/kg of the commercially available syrup. In the presence of their parents, oral sedative premedication in the form of syrup was given 45 min before induction of general anesthesia. On arrival at the operating room, the sedation score, the easy separation score, and behavior at the time of venipuncture were assessed. At the end of the operation, recovery was assessed using the 'Vancouver sedative recovery scale for children'. The incidence of adverse effects was recorded and amnesia was assessed after 24 h. Results Sedation and ease of separation scores were higher in the M group than in the P and CH groups. As regards behavior at the time of venipuncture the proportion of children with no reaction was higher in the M group than in the P group; no cases were recorded in the CH group. The recovery time from anesthesia was shorter in group M (15.3 ± 5.2 min), longer in group CH (24.2 ± 3.7 min), and midway in group P (20.8 ± 3.5 min) ( P P Conclusion Oral midazolam at a dose of 0.5 mg/kg of body weight is a suitable premedication for children. It may be preferred over promethazine and chloral hydrate because of its better sedative effect, good easy separation score, good behavior scores of children at the time of venipuncture, and better recovery from anesthesia with postoperative amnesia.

A comparative study of intranasal midazolam spray and oral midazolam syrup as premedication in pediatric patients

Background: Preoperative preparation of children to alleviate the stress and anxiety related to surgery is an important aspect of balanced anesthesia care, it can not only affect the smoothness of induction and emergence from anesthesia but also the emotional and psychological make-up of the child, considering the pharmacological profile, midazolam is widely considered to be the ideal premedicant. The purpose of our prospective randomized observer-blinded study is to compare the effect of midazolam through oral and intranasal routes and determine the safer, more effective, and acceptable route by children. Subjects and Methods: Sixty patients aged 2–8 years, belonging to the American Society of Anesthesiologist I and II undergoing various surgeries were randomized into two groups of 30 each. Group O received 0.5 mg/kg of oral midazolam syrup, and Group N received 0.2 mg/kg of midazolam intranasal spray. Hemodynamic variables, sedation scores, ease of parental separation, and mask acceptance at the time of induction were studied. Results: Onset of sedation was shorter and the sedation scores were higher in intranasal group, separation from parents and acceptance to mask were satisfactory but statistically insignificant in both the groups. There was no statistical difference in hemodynamic parameters, and no major adverse effects were seen in either group. Conclusion: Both oral and intranasal midazolam are safe and effective as sedative premedication in children.

English

INTRODUCTION: Effective premedication in pediatric patients posted for elective surgeries allays patients' anxiety and reduces risk of post-operative behavioral problems. Oral midazolam and oral ketamine are tried in different doses as pediatric premedicant, but addition of 3mg/kg of oral ketamine with 0.5 mg/kg of oral midazolam resulted in better premedication when compared to oral midazolam 0.5mg/kg or oral ketamine 6mg/kg given alone. MATERIAL AND METHODS: 60 healthy children under 1-8 yrs. age group posted for elective surgeries chosen for this study were randomly divided into two groups of 30 each. Double blinding was done using sealed envelope technique to prevent observer bias. Children with other co-existing illnesses were excluded from the study. Group KM received Ketamine 3 mg/kg and midazolam 0.5 mg/kg + atropine 20 µg/kg (oral route) and Group M received midazolam 0.5 mg/kg and atropine 20 µg/kg (oral route) 30 minutes before proposed induction time. Sedation score, anxiolysis score, parental separation and mask tolerance was assessed in all the patients 30 minutes after administration of the drug. RESULTS: The data collected was analyzed using SPSS statistical software. There was a statistically significant increase in sedation score at 15 and 30 minutes in group KM compared to group M. Parental separation at 30 minutes is peaceful in 30 children (100%) in group KM compared to 24 children (80%) in group M. CONCLUSION: The oral ketamine and midazolam combination produces significantly better anxiolysis, sedation, parental separation and mask tolerance, without hemodynamic alteration, when compared to oral midazolam (0.5mg/kg) given alone.

Is dexmedetomidine superior to midazolam as a premedication in children? A meta‐analysis of randomized controlled trials

In the current published literature, there are controversial results regarding the effectiveness of dexmedetomidine compared with midazolam as premedication in children. The aim of this meta-analysis was to compare the use of dexmedetomidine as a premedication in pediatric patients with that of midazolam. We searched for articles published in English that matched the key words 'dexmedetomidine', 'midazolam', and 'children' in the PubMed, Cochrane Library, Ovid, and Google Scholar databases. Additional studies were identified from the reference lists of the retrieved articles. Only prospective randomized controlled trials (RCTs) that compared the use of dexmedetomidine and midazolam as premedications in children were included. The extraction of data from the articles was performed independently by two authors using a predesigned Excel spreadsheet. The relative risks (RRs), weighted mean differences (WMDs), and their corresponding 95% confidence intervals (95% CIs) were calculated for dichotomous and continuous outcome data using the quality effects model of the MetaXL version 1.3 software. Eleven prospective RCTs (829 children) met our criteria. Compared with midazolam, dexmedetomidine premedication was associated with more satisfactory sedation upon parent separation (eight RCTs [679 children]; RR: 1.25; 95% CI: 1.06, 1.46) and upon mask acceptance (seven RCTs [559 children]; RR: 1.17; 95% CI: 1.01, 1.36). During the postoperative period, premedication with dexmedetomidine lowered the numbers of requests for rescue analgesia (six RCTs [477 children]; RR: 0.55; 95% CI: 0.40, 0.74) and lowered the risks of agitation or delirium (seven RCTs with [466 children]; RR: 0.59; 95% CI: 0.40, 0.88), and shivering (three RCTs [192 children]; RR: 0.33; 95% CI: 0.18, 0.61). However, dexmedetomidine premedication reduced systolic blood pressure (three RCTs [242 children]; WMD: -11.47 mm·Hg(-1) ; 95% CI: -13.95, -8.98), mean blood pressure (three RCTs [202 children]; WMD: -5.66 mm·Hg(-1) ; 95% CI: -8.89, -2.43), and heart rate (six RCTs [444 children]; WMD: -12.71 beat·min(-1) ; 95% CI: -14.80, -10.62), and prolonged the onset of sedation (two RCTs [132 children] WMD: 13.78 min; 95% CI: 11.33, 16.23; I(2) = 0%) relative to midazolam. This meta-analysis demonstrated that dexmedetomidine premedication is superior to midazolam premedication in terms of producing satisfactory sedation upon parent separation and mask acceptance. Dexmedetomidine premedication provides clinical benefits that included reducing the requirements for rescue analgesia and reducing agitation or delirium and shivering during the postoperative period. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with dexmedetomidine should be considered.

Comparative study of oral and trans nasal midazolam as a sedative premedication in paediatric patients

Background: Premedication in pediatric patient before induction of anaesthesia is of vital importance. Midazolam is a benzodiazepine which produces anxiolytic, amnestic, hypnotic and skeletal muscle relaxant effects. Objectives: To evaluate the safety, acceptability, level of sedation and ease of administration of midazolam by using oral and trans nasal route as a sedative premedication in paediatric patient. Materials and Methods: Sixty paediatric patients of ASA grade I or II, aged 2-10 years, undergoing elective surgery were randomly divided into two groups. Group I received oral syrup midazolam 0.5mg/kg and Group II received nasal spray midazolam 0.25mg/kg. Demographic profile, response to drug administration, level of sedation, separation from parents, venipuncture, induction and postoperative recovery scores were noted and statistically analyzed. Results: The study shows that children receiving oral midazolam has better acceptability (group I, 76.66%) than when administered through intranasal route (group II, 53.33%). Sedation score were better at 20 min. in intranasal group (3.06 versus 2.96) than oral group. Post anesthesia recovery scores were similar in both groups. Conclusion: On the basis of our study, we concluded that oral syrup midazolam has better acceptability while intranasal spray midazolam has slightly faster onset without prolonging recovery from anesthesia.

English

BACKGROUND: This study was conducted to see the efficacy of two different doses of oral clonidine as a premedication in pediatric patients. MATERIAL AND METHOD: In a prospective randomized study of 60 cases of 4-12 year old children receiving oral clonidine either 3µg/kg (group C 3) or 4µg/kg (group C 4) as a premedication 90 minutes prior to surgeries. Preoperatively, the level of sedation, response to parental separation, mask acceptance, intravenous cannulation and response to intubation as well as hemodynamic were noted. Postoperative recovery was assessed using Alderate recovery room score. RESULTS: Clonidine 4µg/kg group had higher sedation score compared to clonidine 3µg/kg. At 90 minutes, almost 90% children in C 4 group were asleep but arousable on calling and in C 3 group 33% were asleep, 60% were drowsy and rest 7% children were calm. Parental separation and mask acceptance scores were also higher with clonidine 4µg/kg group. The response to intubation was better attenuated in clonidine 4µg/kg group. There was no respiratory depression or oxygen desaturation at any point of time in our study perioperatively and no delay in postoperative recovery as well as no significant difference in the incidence of post operative nausea and vomiting in both the groups. CONCLUSION: Oral clonidine 4 µg/kg provided better sedation than clonidine 3µg/kg without prolonging the postoperative recovery.

Comparison between dexmedetomidine and midazolam premedication in pediatric patients undergoing ophthalmic day-care surgeries

Midazolam is the most commonly used premedication in children. It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an a2 agonist, has been suggested as an alternative. Dexmedetomidine is a more a2 selective drug with more favorable pharmacokinetic properties than clonidine.Aims:To compare i.v. Dexmedetomidine and Midazolam as premedication in pediatric patients.Settings and Design:Open label single blind study.Material and Methods:60 patients were randomly allocated to group D(n=30) and group M(n=30) and given Inj Dexmedetomidine 0.4 μg/kg diluted in 10 ml slowly i.v. and Inj Midazolam 0.05mg/kg i.v. accordingly. Level of sedation, parent separation, response to induction, blood pressure, pulse, oxygen saturation, post operative agitation and shivering was noted.Statistical Analysis Used:Unpaired student's t-test and chi square test used in this study. P value <0.05 was considered significant.Results:There were significant differences in parental separation acceptance,Response to induction and wake-up behavior score. When compared with group M, patients in groupD were significantly more sedated % minutes after premedication (P<0.001). Post operative agitation and shivering was low in group D in comparision with group M. Though blood pressure and pulse were on lower side in group D than in group M, oxyden saturation remained same in both the groups having no statistical significance.Conclusions:Dexmedetomidine is superior than Midazolam as premedication in pediatric patients with more intense sedation, excellent parent separation, favourable induction conditions, lower incidence of postoperative agitation and shivering along with hemodynamic stability and no respiratory depression.

Comparative evaluation of midazolam and clonidine as pediatric oral premedication.

Background:Clonidine provides many desirable effects like sedation, analgesia, anxiolysis, and hemodynamic stability and these properties make it a potentially useful anesthetic premedication in the pediatric settings. The aim of this study was to compare oral midazolam (0.5 mg/kg), which is considered gold standard with oral clonidine (5 mcg/kg) as a premedication in pediatric patients.Materials and Methods:Sixty children classified as American Society of Anesthesiologists physical status I, aged between 2 and 12, who were scheduled to undergo an elective surgery, were enrolled for a prospective, randomized, and double blind controlled trial. They received either oral midazolam (Group M) or oral clonidine (Group C) 60 minutes before induction of anesthesia and were submitted to an evaluation of anxiety and sedation scores. We also evaluated secondary outcomes such as palatability, parental separation, effect on hemodynamic status, co-operation during venipuncture and facemask application, postoperative analgesic requirement, and recovery profile.Results:Oral midazolam had better efficacy in the preoperative period as sedative and anxiolytic (P < 0.001), allowed better cooperation during venipuncture and facemask application (P < 0.001), whereas, oral clonidine provided better palatability (P < 0.001), parental satisfaction (P < 0.001), stable perioperative hemodynamics (P < 0.001), better postoperative analgesia (P < 0.001), and night sleep pattern (P < 0.05) without any noticeable side effects (P > 0.05).Conclusion:We conclude that under the conditions of this study, oral midazolam is a better medication than clonidine in children in preoperative period while clonidine is a better medication postoperatively with added advantage of palatability, hemodynamic stability, and no significant side effects.

Efficacy of anesthetic premedication in pediatric patients using oral midazolam and acetaminophen. Observational study

Anesthetic premedication with midazolam helps reduce anxiety in the children and the parents, the need for analgesic use, and the development of negative psychological events during the postoperative period; it also results in shorter inhalation induction and orotracheal intubation. Compounded preparations have been developed using ampoules for parenteral administration mixed with flavor modifiers in order to improve acceptance. To determine the efficacy of premedication using a mix of midazolam plus acetaminophen, a prospective descriptive observational study was conducted in 216 children ASAI or II, scheduled for surgical or diagnostic procedures requiring general anesthesia. Anxiety-sedation scales were given (modified Yale scale and RASS), and tolerance to separation from the parents was assessed. ResultsThe RASS scale applied at the time of induction showed that 92% of the patients were at an appropriate level of sedation to tolerate facemask inhalation induction, and 86% of patients tolerated well their separation from their parents. It was found that age, gender, education, socioeconomic status, pre-anesthetic check type (telephonic or in person), or a history of previous anesthesia, did not have a statistically significant correlation with the degree of anxiety-sedation. ConclusionsPremedication with a compounded preparation does reduce anxiety at the time of separating the child from its parents, and allows a good acceptance of the inhaled anesthetic induction.

Feasibility of Carbidopa Premedication in Pediatric Patients: A Pilot Study

To verify the potential role and feasibility of carbidopa premedication in pediatric patients undergoing ¹⁸F-DOPA (Fluorine-18 fluorodihydroxyphenylalanine) PET scanning. For this limited study, 5 patients (M:F=3:2; mean age 4.8 years) with a positive history for neuroblastoma who had been referred to our institution for instrumental monitoring during clinical follow-up were enrolled. In all cases, two consecutive ¹⁸F-DOPA PET scans, the first without carbidopa and the second with carbidopa premedication, were scheduled: patients received 4 MBq/kg of radiotracer and a dose of 2 mg/kg of carbidopa. Dedicated VOIs were drawn on the basal ganglia, pancreas, liver, and renal cortex. These regions were semiquantitatively analyzed at both the first and at the second ¹⁸F-DOPA scan, and mean SUV(max) values were compared using the t-test. On a visual basis, a clear reduction in the abdominal accumulation of (18)F-DOPA was observed in all cases after carbidopa premedication. This reduction related both to the biliary structures and the excretory system, and was accompanied by a generalized increase in soft tissue uptake. The semiquantitative analysis documented an absolute increase in SUV(max) after carbidopa premedication in the basal ganglia (3.4±1.3 vs. 2.1±0.8) and liver parenchyma (2.2±0.5 vs. 1.5±0.5), whereas SUV(max) decreased in the renal cortex (1.7±0.8 vs. 3.7±1.0) and the pancreas (2.3±0.6 vs. 3.5±0.5). The changes in SUV(max) were statistically significant for the pancreas and liver parenchyma (p=0.022 and 0.045, respectively), but not for the basal ganglia and renal cortex (p=0.143 and 0.15, respectively). Carbidopa premedication in the pediatric population appears feasible and seems to influence ¹⁸F-DOPA distribution in the liver and pancreas in a manner similar to that reported in adults. Larger series are however needed to properly define the clinical role of carbidopa premedication in children.

Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg

Midazolam premedication administered by the intranasal route is noninvasive with good bioavailability. Atomised intranasal midazolam spray ensures accurate drug dosage and better patient acceptability, with rapid onset of action and virtually complete absorption. Sixty pediatric patients scheduled for elective surgeries were administered atomised intranasal midazolam. Two doses of midazolam, of 0.2 and 0.3 mg/kg, were compared. Children were observed for achieving satisfactory sedation and separation scores, and face mask acceptance. At 10 and 20 min of nasal administration, 70 and 76% of the children, respectively, in the 0.3 mg/kg dose group, while 40 and 63% of the children, respectively, in the 0.2 mg/kg group were adequately sedated. Similarly, at 10 and 20 min after administration, 66.6 and 73.3% of children, respectively, in the 0.3 mg/kg group, and 30 and 60% in the 0.2 mg/kg group were easily separated from their parents. With regard to face mask acceptance, 33.3% of patients in the 0.3 mg/kg group and 16.6% in the 0.2 mg/kg group accepted the mask easily. Atomised midazolam at 0.3 mg/kg is safe, and achieves faster sedation and better separation scores as compared to 0.2 mg/kg.