Comparing the Effects of Intranasal Dexmedetomidine with Midazolam in Preparation of Children Scheduled for Elective Surgery

Relieving preoperative anxiety is an important concern for the pediatric anesthesiologists. Anxiety can cause aggressive reactions and increase child’s distress and might even make postoperative pain management impossible. Oral midazolam has been the most frequently used premedication in children. The purpose of this study was to evaluate preoperative sedative effects, anxiety level changes and the ease of child-parent separation of preoperative intra nasal dexmedetomidine compared with intra nasal midazolam in children scheduled for elective surgery. Child cooperation in the operating room (OR) and recovery time were also compared.
This prospective, double-blinded, randomized study was done on sixty 2-8 year old, ASA I _ II children scheduled for elective surgery in teaching hospitals in Rasht, Iran. Using random blocks, the children were divided into 2 equal groups (group D and group M). Group D received 1µg/kg intranasal dexmedetomidine and group M received 2 mg/kg intranasal midazolam 30 minutes before entering to the OR. The ease of child_ parent separation according to Feld score, cooperation for inserting the IV line, accepting the anesthesia mask were assessed and compared between the two groups using Chi square, t-test and KS statistical tests.
The study was done on 49 (81.7%) boys and 11 (18.3) girls with the mean age of 4.45±1.67 years. No statistical difference was seen between the two groups in sex, age, basal heart rate (HR), blood pressure (BP) and arterial O2 saturation (SpO2). HR and BP were also statistically equal 15 minutes after administration of the drug and at the time of entering to the OR. But SpO2 levels in both times were higher in group D than in group M. (p= 0.016 and p= 0.036, respectively). Children receiving midazolam separated from parents more easily and accepted the anesthesia mask better than the Dexmedetomidine group. (p=0.013) But there was no difference between two groups in IV line insertion (p=0.221).
Administration of intranasal midazolam 30 minutes before surgery is superior to dexmedetomidine in ease of child_parent separation and acceptance of anesthesia mask. But dexmedetomidine causes less respiratory depression than midazolam.