Sedative Premedication Research Articles

Assessing the Premedication Properties of Sublingual Melatonin in Young Women Undergoing Cesarean Section With Spinal Anesthesia: A Double-Blind Randomized Study.

Preoperative anxiety can negatively impact patient outcomes by influencing the intraoperative requirements for anesthetics and analgesics, increasing postoperative pain intensity, and augmenting the need for analgesia. Moreover, it may contribute to higher rates of postoperative morbidity and mortality following certain types of surgery. This study investigates the anxiolytic and sedative properties of sublingual melatonin as a premedication agent in young females undergoing cesarean section under spinal anesthesia. A double-blind, randomized, placebo-controlled trial was conducted in Nasiriyah, Iraq. Eighty females were included, 40 in each group, based on specific inclusion and exclusion criteria. Premedication was administered in the morning, 60 minutes before the procedure. In the melatonin group (M), patients received 10 mg of sublingual melatonin, while the placebo group (P) received placebo premedication. Anxiety and sedation levels were evaluated three times: before taking premedication, five minutes before the insertion of the spinal needle, and one hour postoperatively, using the visual analog scale and Richmond Sedation Scale. The results show a highly significant P-value regarding anxiety levels between the M Group and P Group (p-value < 0.001). There was a significant difference in the median sedation scores between the studied groups at pre-spinal insertion and postoperatively (p-value < 0.001). The mean heart rate in the M Group was significantly lower than in the P Group (p-value = 0.0019). Significant differences were noted in systolic and diastolic blood pressures between the two groups, measured five minutes before and after spinal needle insertion (p-value < 0.001). These findings contribute to understanding the impact of sublingual melatonin as an anxiolytic and sedative premedication agent on patients undergoing elective cesarean sections under spinal anesthesia. Further research is warranted to fully elucidate the benefits and implications of melatonin administration in such procedures.

A bibliometric analysis of research on pediatric preoperative anxiety (2007-2022).

This study aimed to analyze the current state of research on preoperative anxiety in children through CiteSpace, VOSviewer, and the identification of hot spots and frontiers. Relevant data were retrieved from the Web of Science Core Collection using the search terms children and preoperative anxiety. Data were analyzed using VOSviewer (version 1.6.18), CiteSpace (5.7. R5) software, and Scimago Graphica. A total of 622 articles were published between 2007 and 2022, with an increasing trend over time. Kain, Zeev N. (13; 2.09%) and Dalhousie University (15; 2.41%) were the most influential authors and most prolific institutions, respectively. The United States (121; 19.45%) was the country with the most publications. Pediatric anesthesia (55; 8.84%) had the most publications. High-frequency keywords were categorized into three themes, including nonpharmacologic interventions for preoperative anxiety in children, preoperative medications, and risk factors for anxiety; of these, "predictor" (38; 2016) and "sedative premedication" (20; 2016) were the most studied keywords over the past 6 years. "Distraction" (67; 2019) and "dexmedetomidine" (65; 2019) have been the main areas of interest in recent years. Research on preoperative anxiety in children has been the focus of increasing attention over the past fifteen years, with the majority of publications from high-income countries. This review provides a useful perspective for understanding research trends, hot topics, and research gaps in this expanding field.

Effects of intranasal dexmedetomidine versus intranasal midazolam as premedication in children with tetralogy of Fallot undergoing corrective cardiac surgery: A randomized trial.

This prospective, randomized, double-blind trial was done to compare intranasal dexmedetomidine and intranasal midazolam as premedication for sedation and ease of child-parent separation in pediatric patients of tetralogy of Fallot (TOF) undergoing corrective cardiac surgery. Forty children with TOF, between 1 and 10 years, undergoing corrective cardiac surgery were included in the study and, after randomization, were given intranasal midazolam (0.2 mg/kg) or intranasal dexmedetomidine (1 µg/kg), 30 min before shifting to the operation room (OR). Patients were assessed for sedation and child-parent separation, along with hemodynamic parameters, respiratory rate, and oxygen saturation (SpO2) 30 min after drug administration, at the time of shifting inside the OR, and at the time of induction of anesthesia. Both groups had comparable child-parent scores, hemodynamic parameters, SpO2, and respiratory rate. However, the dexmedetomidine group had significantly better sedation levels than the midazolam group patients at the time of shifting inside the OR (dexmedetomidine group: 3.55 ± 0.82 vs. midazolam group: 2.80 ± 0.83; P = 0.007) and at the time of induction of anesthesia (dexmedetomidine group: 3.40 ± 0.75 vs. midazolam group: 2.70 ± 0.86; P = 0.009). Intranasal dexmedetomidine provides better sedation than midazolam, with similar child-parent separation scores and hemodynamic parameters, respiratory rate, and SpO2. No adverse events were observed in both groups. A study on a larger population will help in further establishing the safety and superiority of dexmedetomidine and will further its regular use as an intranasal premedication.

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.

Differential Utilization of Parental Presence and Premedication for Induction of Anesthesia in Pediatric Patients

PurposeKnown disparities exist in pain treatment between African American, Latino, and White children, and a recent study described ‘adultification’ of Black children, with Black children being less likely to have a parent present at induction of anesthesia and less likely to receive an anxiolytic premedication before proceeding to the operating room. The aim of this study is to identify differences based on race and socioeconomic status when treating children and their families for anesthetic induction. We hypothesize that differences exist such that certain populations are less likely to receive sedative premedication and less likely to have parents present at induction of anesthesia. DesignThis retrospective cohort study utilized demographic data along with types of surgical procedure, type of anesthesia induction, use of premedication, and involvement of child life services (including the plan for parental presence at induction) were obtained for all pediatric patients presenting for anesthetics from February 2019-March 2020. MethodsStatistical analysis consisted of fitting logistic mixed effects models for caregiver presence or for midazolam use during induction, with fixed effects for sex, race, ethnicity, language, public/private insurance, and anesthetic risk, and with provider as a random effect. FindingsA total of 7753 patients were included in our statistical analyses, Parental presence focused on 4102 patients with documentation from child life specialists (Figure 2). Females were less likely than males to have parents present at induction (OR 0.77, CI [0.67, 0.89]). When looking at race, American Indian/Alaskan Native patients (OR 0.23 [CI 0.093, 0.47]) and Black/African American patients OR 0.64 [CI 0.47, 0.89]) were less likely to have a parent present induction than White patients. Patients with private insurance were more likely to have parents present than patients with public insurance (OR 0.63 CI [0.5, 0.78]). These findings held true in age separated sensitivity analysis. For midazolam usage, Asian patients were less likely to receive this premedication (OR 0.65 CI [0.49, 0.86]). ConclusionsThis study supports previous work showing differential use of parental presence at induction based on race. Additionally, it also shows different treatment based on sex and public insurance status, a surrogate for socioeconomic status.

Dexmedetomidine with or without Pregabalin Premedication for Conscious Sedation ‎during Cataract Surgery under Topical Anesthesia

Dexmedetomidine with or without Pregabalin Premedication for Conscious Sedation ‎during Cataract Surgery under Topical Anesthesia

Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnetic resonance imaging: the MIDEX MRI trial

BackgroundChildren under 6 years who need magnetic resonance imaging usually require sedation to obtain best quality images, but the optimal sedation protocol remains to be determined. In 2018, we showed a 22% interruption in image acquisition during magnetic resonance imaging when performing a propofol-based sedation using a bolus approach. As non-pharmacological premedication is often insufficient to reduce the anxiety of children related to parental separation, pharmacological premedication may be useful to facilitate the induction of anesthesia. In our institution, effective premedication is obtained oral intake of midazolam, though its administration relies on patients’ compliance and could also lead to paradoxical reaction. Dexmedetomidine has a safe profile in the pediatric population and can therefore represent an interesting alternative. The primary objective of this trial is to demonstrate the superiority of intranasal dexmedetomidine compared to oral midazolam as premedication in reducing the occurrence of any event requiring temporary or definitive interruption of the examination to allow anesthesiologist intervention in children undergoing magnetic resonance imaging under propofol sedation.MethodsIn this single-center, prospective, randomized, double-blind, double-dummy, active comparator-controlled, superiority trial, we planned to include 250 patients, aged 6 months to 6 years, undergoing a scheduled magnetic resonance imaging requiring the presence of an anesthesiologist. After informed consent, the patients will be randomized to receive either oral midazolam or intranasal dexmedetomidine as premedication. The data will be analyzed in intention to treat, using Kolmogorov–Smirnov Z, chi-square, Wilcoxon, and Mann–Whitney U tests. A P-value < 0.05 will be considered statistically significant.DiscussionThe MIDEX MRI study will assess the efficacy of intranasal dexmedetomidine compared to oral midazolam to improve the quality of a propofol-based sedation prior to magnetic resonance imaging, without negative repercussion on the postoperative period.Trial registrationClinicalTrial.gov NCT05192629. Registered on 14 January 2022. Protocol version 2.1

PERIOPERATIVE ANXIETY IN CHILDREN: NARRATIVE REVIEW

Preoperative anxiety in children is common and can have negative effects on their overall surgical experience. Several factors, such as age, personality traits, and past medical experiences, can contribute to increased preoperative anxiety. Behavioral interventions, such as distraction techniques, parental presence at induction of anesthesia, and preoperative preparation programs, can be effective in reducing anxiety. Behavioral family preparation programs have been found to reduce the number of children requiring preoperative sedation, but they may not be practical for all centers. Anesthesiologists and child life specialists can play an essential role in reducing anxiety in children by interacting with them in an age-appropriate way, providing therapeutic play experiences, and offering developmentally appropriate language. Distraction techniques, such as non-procedural distracting talk, electronic devices, music, stories, and guided imagery, can also help children cope with anxiety. Pharmacological interventions, such as sedative premedication, should be used with caution, especially for children with neurodevelopmental disorders, due to potential drug interactions and increased risks of upper airway obstruction.

Dexmedetomidine versus midazolam as intranasal premedication for intravenous deep sedation in pediatric dental treatment

Background/purposeOptimal sedation management for pediatric dental treatment demands special focus as it's tubeless and shares a same oral space. The study was to evaluate dexmedetomidine compared to midazolam for intranasal premedication in pediatric dental treatment under intravenous deep sedation. Materials and methodsA hundred children aged 3–7 years scheduled for elective dental treatment under intravenous deep sedation anesthesia were enrolled, of whom 50 children (Group D) were intranasally premedicated with 2.0 μg/kg dexmedetomidine and the remaining 50 children (Group M) received traditional 0.2 mg/kg midazolam. Acceptance rate of venipuncture was regarded as the primary endpoint. ResultsThe acceptance rate of venipuncture in Group D and Group M were 76% versus 52%, respectively (P = 0.021). More children in Group M complained about bitter/sour taste than Group D (62% vs. 8%, P < 0.001). Intraoperatively, children in Group M were found to have more choking cough than Group D (30% vs. 9%, P = 0.003), and patients in Group M required more suction (18 [36%] in Group M vs. 4 [8%] in Group D, P = 0.001). There were no significant differences between the groups in the incidences of temporal hypoxemia (SpO2 ≤ 90%), however, two children in Group M experienced hypoxemia over 10 s. ConclusionCompared to the 0.2 mg/kg midazolam, children premedicated with 2.0 μg/kg intranasal dexmedetomidine showed superior venipuncture acceptance, had less intraoperative choking cough and required fewer suction. It seems to be a good alternative to midazolam as premedication for deep sedation in pediatric dental treatment.

A Comparative Study on Effectiveness of Parental Presence versus Sedative Premedication for Reducing Anxiety in Children Undergoing General Anesthesia.

Preoperative anxiety is an important, yet often unattended problem in children. Minimizing anxiety and distress at the time of anesthetic induction may reduce adverse psychological and physiological outcomes. Sedative premedication and parental presence during anesthesia induction are among the most commonly employed strategies for reducing child anxiety. The study aimed to compare the effectiveness of a pharmacological intervention (premedication with midazolam) versus behavioral intervention (parental presence) in reducing preoperative anxiety in children undergoing general anesthesia. Sixty patients of age group of 4-12 years, of ASA Grade 1 and 2 and either sex posted for elective surgery under general anesthesia were divided into two groups of 30 each Group M (midazolam group) and Group P (parental presence). Group M received intravenous midazolam 0.03-0.05 mg/kg preoperatively and anxiety was measured in preoperative room, during separation from parents and during introduction of anesthesia mask, whereas in Group P, parents accompanied the child inside the operation theater and anxiety was measured at preoperative room and during introduction of mask. Parental anxiety was measured in both groups at preoperative room and waiting room. Modified Yale Preoperative Anxiety Scale (mYPAS) and State Trait Anxiety Inventory (STAI) tool was used to measure anxiety in children and parents, respectively. The mean mYPAS score while the introduction of anesthesia mask in Group M was 31.30 ± 12.04 and in Group P was 63.19 ± 25.31, and the difference was found to be statistically significant (P = 0.001). In preoperative room, there was no significant difference in anxiety in the two study groups. The mean STAI score in Group P was 45.63 ± 1.45 and in Group M was 41.10 ± 1.69, and the difference was found to be statistically significant (P = 0.001). In preoperative room, parental anxiety was found to be comparable among the two groups. The mean duration of induction of anesthesia in Group M was 5.53 ± 1.01 min, and in Group P, it was 8.77 ± 2.03 min. The difference was found to be statistically significant (P = 0.001). Both interventions were effective in reducing anxiety in children, but midazolam was more effective compared to parental presence. Parents in Group M were less anxious in the waiting room than Group P. Children in Group M were more compliant during the induction of anesthesia, hence a lesser duration of induction than Group P.

Intranasal Ketamine for Premedication in Children: A Comparative Study in Ghana

BACKGROUND: Premedication is helpful especially in children in reducing the stress associated with anesthesia and surgery. Pediatric patients for surgery in Korle Bu Teaching Hospital are currently not sedated preoperatively due to unavailability of effective pediatric sedative preparations. Ketamine is readily available, inexpensive, and has been used for pediatric sedation through various routes with good outcomes in other geographical regions. Its intra-nasal use shows promise and avoids the anxiety and pain associated with establishing of an intravenous access and administration of drugs intravenously and intramuscularly. AIM: The aim of this study was to assess the efficacy of intranasal ketamine as premedication for pre-operative sedation. MATERIALS AND METHODS: A double-blind, randomized, and controlled trial was conducted on 76 pediatric elective surgical patients aged between 1 and 6 years at the Korle-Bu Teaching Hospital. Subjects were randomly assigned to receive 10 mg/kg intranasal ketamine (Treatment group) or 0.9% normal saline (Control group) 30 min before induction of anesthesia. Ease of separation from parents was assessed before (Pre-intervention) and 30 min after administration of intranasal solution (Postintervention). The level of sedation and acceptance of face mask were assessed 30 min after intranasal administration. RESULTS: The mean separation score in the treatment group was significantly lower pre-intervention (p = 0.026) but significantly higher 30 min post-intervention compared to control group (p &lt; 0.0001). There was a significantly higher mean sedation score (2.8 ± 0.8 vs. 1.7 ± 0.7; p &lt; 0.0001) and face mask acceptance score (3.4 ± 0.8 vs. 1.9 ± 1.2; p &lt; 0.0001) among the treatment group compared to the control group. The incidence of salivation was significantly higher among the treatment group compared to the control group (17.9% vs. 0%; p = 0.007). CONCLUSION: The use of intranasal ketamine as premedication preoperatively in pediatric surgical patients is safe and results in improved sedation scores, better separation scores, and acceptance of face mask.

Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing Midazolam, Clonidine, and Dexmedetomidine

PurposeSedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia. DesignA single-center randomized controlled trial. MethodsThis is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period. FindingsThe final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group. ConclusionsWhen used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

The Preoperative Administration of Nebulized Dexmedetomidine Versus Nebulized Midazolam as a Sedative Premedication before Pediatric Surgery

The Preoperative Administration of Nebulized Dexmedetomidine Versus Nebulized Midazolam as a Sedative Premedication before Pediatric Surgery

The Preoperative Administration Of Nebulized Dexmedetomidine Versus Nebulized Midazolam as a Sedative Premedication before Pediatric Surgery

The Preoperative Administration Of Nebulized Dexmedetomidine Versus Nebulized Midazolam as a Sedative Premedication before Pediatric Surgery

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).

Dexmedetomidine compared to ketofol for sedation in pediatric patients undergoing dental procedures: a double-blind, randomized clinical trial

Background &amp; objective: Hospital phobia and anxiety are still prevalent issues in the pediatric patients. Various sedative regimes have been in dental practice, but the evidence for safe and effective sedative drugs in this population is scarce. We compared the safety and efficacy of intravenous combination of ketamine plus propofol (ketofol) with dexmedetomidine (Dex) as a sedative premedication in anxious children undergoing dental pulp therapy.&#x0D; Methodology: This double-blind, randomized clinical study recruited 40 anxious children who were to undergo dental pulp therapy. The study participants were allocated into two groups (20 subjects each). Subjects in Group I received ketofol solution (ketamine/propofol mixture, each mL contains 2 mg of ketamine plus 4 mg of propofol). A loading dose of 0.3125 mL/kg was administered intravenously (IV) over 10 min, followed by maintenance infusion at a rate of 0.05-0.125 mL/kg/h. Subjects in Group II received the Dex solution (4 µg/mL). A loading dose of 2 µg/kg was administered IV over 10 min, followed by a maintenance infusion of 0.1-1 µg/kg/h. Non-invasive blood pressure, SpO2, heart rate (HR), and respiratory rate (RR) were assessed at baseline, at 2 min, and then at 5 min intervals till 60 min. Ramsay sedation score was assessed before, during, and after the procedure and Aldrete's recovery rating score was assessed at the end of the procedure.&#x0D; Results: Compared to the Dex group, the ketofol group showed a statistically significant shorter sedation onset (P = 0.017) but longer discharge time as well as higher rescue dose and a number of interruptions (P &lt; 0.001). There was more stable respiration in Dex group, but with significantly more bradycardia. The mean arterial blood pressure showed some episodes of significant elevations with ketofol compared to Dex, while a biphasic response was observed in the Dex group.&#x0D; Conclusion: The use of Dex induced successful sedation of children who underwent tooth pulp therapy in terms of minimizing the number of interruptions during the procedure, the frequency of rescue drugs administration as well as the total procedure and discharge times. Dexmedetomidine showed no adverse respiratory effects but was associated with bradycardia and biphasic mean blood pressure alterations that require careful titration.&#x0D; Abbreviations: HR: heart rate; IV: Intravenous; RSS: NMDA: N-Methyl D-Aspartate PACU: Post Anesthesia Care Unit; Ramsay sedation score&#x0D; Citation: Hussien RM, Emam DF, Shoukry AA. Dexmedetomidine compared to ketofol for sedation in pediatric patients undergoing dental procedures: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2022;26(5):595-601; DOI: 10.35975/apic.v26i5.2016

Nebulized vs. oral midazolam as a sedative premedication in pediatric anesthesia: A randomized controlled double-blinded study

ABSTRACT Objective This study was carried out to compare different routes of midazolam administration (nebulized vs. oral) to achieve a satisfactory level of sedation, RAMSAY Sedation Score (RSS) of 4, within 30 minutes of midazolam administration in pediatric operative patients. Methods After approval of the ethical committee in Kasr Al-ainy university hospital and obtaining written consent from parents/legal guardians; Seventy-two pediatric patients scheduled for general and urological surgical operations under general anesthesia were included in this randomized double-blinded study. Patients were randomly assigned into one of the two equal groups. Group N: 36 children received nebulized midazolam 0.2 mg/kg in 3 ml normal saline plus 5 ml clear juice 30 min before undergoing general anesthesia (GA). Group O: 36 children received oral midazolam 0.5 mg/kg in 5 ml clear juice plus nebulizer of 3 ml normal saline 30 min before undergoing general anesthesia. Results We found no statistical difference between nebulized and oral midazolam regarding drug acceptance, peri-operative (sedation scores, hemodynamics, and side effects); P-value >0.05 for all values. Conclusion Nebulized midazolam is a good alternative to oral midazolam as a sedative premedication in pediatrics.

Comparison of Premedication with Midazolam and Dexmedetomidine on Sedation and Anxiety in Controlled Hypertensive Patients Undergoing Elective Surgery under General Anaesthesia

Background: The study is a double-blind randomized trial aiming to compare intravenous midazolam and dexmedetomidine as premedication for sedation and anxiety control in controlled hypertensive patients undergoing elective surgery under general anaesthesia.&#x0D; Methods: The patients who met the inclusion criteria were randomly divided into two groups of 50 patients each. Thirty minutes prior to induction, Group 1 patients received midazolam 0.02mg/kg i.v and Group 2 patients received dexmedetomidine 1mcg/kg i.v in 100 ml normal saline over 10 minutes. Preoperative sedation and anxiety levels and vital parameters (heart rate, blood pressure, respiratory rate, arterial oxygen saturation) were assessed for 30 min at every 5 minutes interval.&#x0D; Results: Preoperative sedation was found to be better with dexmedetomidine as compared to midazolam. Decrease in anxiety was comparable in both the groups. Significant fall in heart rate was observed in dexmedetomidine group but it was within the acceptable limits for age. Mean arterial pressure was comparable in both the groups. There was no statistical difference between the groups with respect to respiratory rate and arterial oxygen saturation.&#x0D; Conclusion: Dexmedetomidine provides better sedation and good anxiety control with better maintainence of hemodynamic parameters as compared to midazolam. Thus it is a safe and effective drug to be used for premedication in controlled hypertensive patients.

Premedication for Nonemergent Neonatal Intubation: A Systematic Review.

This systematic review evaluates research regarding the use of premedication for nonemergent neonatal intubation. Unmedicated intubation is associated with adverse outcomes such as physiologic instability and decompensation, repeat and prolonged intubation attempts, and trauma. Included studies compared medicated intervention groups against an unmedicated control. Medications vary greatly across studies and include anesthetics, opioids, benzodiazepines, barbiturates, vagolytics, and neuromuscular blockades (muscle relaxants). A comprehensive search of randomized control trials, retrospective cohort studies, and prospective observational studies was completed from the electronic databases of CINAHL EBSCOhost, Ovid MEDLINE, PubMed, EMBASE, Google Scholar, Cochrane Collaboration, and ClinicalTrials.gov and footnotes were used to complete the search. Twelve studies are included in this review dating back to 1984 and are from 5 countries. Outcome measures include changes in heart rate, oxygen saturation, and blood pressure; number and duration of attempts to intubate; and trauma to the oral cavity and upper airway. Twelve studies are included in this review and include 5410 patients. No studies were excluded based on level of evidence or quality appraisal. Findings in this review support the recommendation that opioids and vagolytic agents should be used for premedication for nonemergent neonatal intubation and adjuvant sedation and muscle relaxants should be considered.

Intranasal Dexmedetomidine Versus Midazolam as Sedative Premedication for Children in Day Case Surgery

Intranasal Dexmedetomidine Versus Midazolam as Sedative Premedication for Children in Day Case Surgery