A comparison of oral dexmedetomidine and oral midazolam as premedicants in children

Sajid, Binu; Mohamed, Taznim; Jumaila, M

doi:10.4103/joacp.joacp_20_18

Cited by 18 publications

(18 citation statements)

References 18 publications

(42 reference statements)

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“…Thirty minutes after receiving the study drug by the atomiser, the ease of parental separation was assessed and the patients were transferred to the operation theatre. The reaction of the child to parental separation was evaluated according to a well validated and reliable Parental Separation Anxiety Score, PSAS (1: child separates easily, 2: child whimpers, but is easily reassured, 3: child cries and cannot or difficult being assured, 4: child crying and clings to parents) and a score of ≤2 considered satisfactory 18 . Inside the operation theatre, standard monitoring was instituted and venous cannulation was attempted at the site of the EMLA cream application on the dorsum of the hand using a 20-gauge cannula.…”

Section: Methodsmentioning

confidence: 99%

“…The reaction of the child to parental separation was evaluated according to a well validated and reliable Parental Separation Anxiety Score, PSAS (1: child separates easily, 2: child whimpers, but is easily reassured, 3: child cries and cannot or difficult being assured, 4: child crying and clings to parents) and a score of 2 considered satisfactory. 18 Inside the operation theatre, standard monitoring was instituted and venous cannulation was attempted at the site of the EMLA cream application on the dorsum of the hand using a 20-gauge cannula. The ease of venous cannulation was assessed by the Groningen Distress Rating Scale (GDRS) score 19 (Grade 1 À child is calm, Grade 2 À mild distress, Grade 3 À serious distress but in control, Grade 4 À serious distress and out of control, Grade 5 À panic).…”

Section: Study Procedures and Assessment Of Outcomementioning

confidence: 99%

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Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Hebbar K,

Reddy,

Luthra

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied. OBJECTIVE To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery. DESIGN A prospective randomised double-blind trial. SETTING A tertiary teaching hospital. PATIENTS Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery METHODS Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg−1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg−1 (Group K, n = 32) 30 min before surgery. OUTCOMES MEASURED The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (Heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted. RESULTS The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, −0.406; 95% CI, −0.621 to −0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, −0.374; 95% CI, −0.650 to 0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported. CONCLUSION Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.

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Section: Methodsmentioning

confidence: 99%

Section: Study Procedures and Assessment Of Outcomementioning

confidence: 99%

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Hebbar K,

Reddy,

Luthra

et al. 2023

European Journal of Anaesthesiology

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“…The dosing recommendation for intravenous procedural sedation is to start with a loading-dose of 1 μg/kg over a period of 10 min, followed by a maintenance dose of 0.6 μg/kg/h, titrated to the desired clinical effect, with doses ranging from 0.2-1 μg/kg/h [4]. Single oral doses range from 2-4 μg/kg [10,11], intranasal from 0.5-2 μg/kg [12], and buccal from 1-4 μg/kg [13,14]. DEX 1 μg/kg intranasally or intravenously is seen equivalent to midazolam 0.1-0.2 mg/kg intranasally or 0.5 mg/kg orally [12], with a more favorable effect to side effect ratio [15].…”

Section: Pharmacokineticsmentioning

confidence: 99%

Dexmedetomidine in Psychiatry: Repurposing of its Fast-Acting Anxiolytic, Analgesic and Sleep Modulating Properties

et al. 2022

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Drug repurposing is a strategy to identify new indications for already approved drugs. A recent successful example in psychiatry is ketamine, an anesthetic drug developed in the 1960s, now approved and clinically used as a fast-acting antidepressant. Here, we describe the potential of dexmedetomidine as a psychopharmacological repurposing candidate. This α2-adrenoceptor agonist is approved in the US and Europe for procedural sedation in intensive care. It has shown fast-acting inhibitory effects on perioperative stress-related pathologies, including psychomotor agitation, hyperalgesia, and neuroinflammatory overdrive, proving potentially useful in clinical psychiatry. We offer an overview of the pharmacological profile and effects of dexmedetomidine with potential utility for the treatment of neuropsychiatric symptoms. Dexmedetomidine exerts fast-acting and robust sedation, anxiolytic, analgesic, sleep-modulating, and anti-inflammatory effects. Moreover, the drug prevents postoperative agitation and delirium, possibly via neuroprotective mechanisms. While evidence in animals and humans supports these properties, larger controlled trials in clinical samples are generally scarce, and systematic studies with psychiatric patients do not exist. In conclusion, dexmedetomidine is a promising candidate for an experimental treatment targeting stress-related pathologies common in neuropsychiatric disorders such as depression, anxiety disorders, and posttraumatic stress disorder. First small proof-of-concept studies and then larger controlled clinical trials are warranted in psychiatric populations to test the feasibility and efficacy of dexmedetomidine in these conditions.

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“…7,8 One methodology utilized dexmedetomidine, a highly selective alpha-2 agonist with both sedating and analgesic properties that binds to receptors in the spinal cord and locus coeruleus. 9 In the current pediatric literature, dexmedetomidine is used for preoperative anxiety, 10 procedural sedation, 11,12 emergence delirium, [13][14][15] and intensive care unit sedation. 9 There are a few reports of intraoperative use for pain control.…”

Section: Introductionmentioning

confidence: 99%

An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

Chiem

Franz

Bishop

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Using plan-do-study-act (PDSA) cycles, this quality improvement (QI) project aimed to standardize an anesthetic protocol to optimize multimodal pain management for pediatric open inguinal hernia repair (OIHR). Methods: PDSA cycle 1: in December 2017, we standardized the intraoperative OIHR anesthesia protocol by replacing transversus abdominis plane (TAP) or ilioinguinal-iliohypogastric (II) blocks and fentanyl with exclusively II blocks and fentanyl. PDSA cycle 2: in January 2019, we used an opioid sparing strategy, replacing II blocks and fentanyl with II blocks and dexmedetomidine. We used statistical process control (SPC) charts to analyze data from the medical record. Outcome measures included the percent of patients requiring rescue morphine in the postanesthesia care unit (PACU), maximum PACU pain score, PACU length of stay (LOS), and anesthesia preparation duration. Results: The team performed a total of 641 pediatric OIHRs between July 2015 and June 2021. The three groups included 203 patients in our baseline group, 127 patients in the PDSA cycle 1 group, and 311 patients in the PDSA cycle 2 group. Special cause variation (SCV) occurred for the percent of patients requiring rescue morphine, anesthesia preparation duration, and PACU LOS. The percent of patients requiring rescue morphine showed improvement. Anesthesia preparation duration improved compared to baseline. There was no SCV detected in the SPC chart for maximum PACU pain score. Conclusion: We implemented an opioid sparing anesthetic protocol for pediatric OIHR utilizing II blocks and dexmedetomidine without adversely affecting postoperative pain score or morphine rescue rate over 6 years.

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A comparison of oral dexmedetomidine and oral midazolam as premedicants in children

Cited by 18 publications

References 18 publications

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Dexmedetomidine in Psychiatry: Repurposing of its Fast-Acting Anxiolytic, Analgesic and Sleep Modulating Properties

An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

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