Comparison of three Oral Premedication Dextrometorphan, Diphenhydramine and Midazolam in Pediatric Eye Exam under Anesthesia

The pre anesthetic management and separation anxiety of infants and children can be a challenge for the anesthesiologist. In this study we compared the effects of dextromethorphan، diphenhydramine and midazolam for this purpose.

Ninety 1-6 year old patient candidate for Eye Examination Under Anesthesia (EUA) were randomly assigned into one of 3 groups receiving Diphenhydramine syrup (1mg/kg)، Dextromethorphan syrup (1mg/kg) or oral Midazolam (0. 3mg/kg) 20 to 30 minutes before entering into the operating room، and were evaluated in a randomized clinical trial. Sedation score was evaluated 1)at 20 minutes after premedication and with the child untouched، 2)on separation from parents، 3)during mask induction and IV line insertion and 4)15 minutes from the beginning of recovery. Duration of anesthesia and recovery were considered too. One way ANOVA and repeated measurement of analysis was used for data analysis.

sedation scores before the child getting touched were significantly better for group dextromethorphan (p = o. o4). There was no statistically significant difference among groups on separation from parents (p=0. 348). Sedation scores were significantly better in Dextromethorphan group during induction of anesthesia and in the recovery too (p=0. 002 and p=0. 001 respectively). There were no significant differences among groups in duration of anesthesia and recovery.

Our finding showed that dextromethorphan can provide an acceptable level of sedation and anxiolysis in children without increasing the recovery time and is comparable to midazolam، as a routine premedication in this setting.