A comparison of oral midazolam and oral dexmedetomidine as premedication in pediatric anesthesia

Abstract

Context:Oral premedication is widely used in pediatric anesthesia to provide preoperative anxiolysis and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but newer drugs such as the α2-agonists have emerged as alternatives for premedication in children.Aims:The aim of this study was to compare clinical effects of oral midazolam and oral dexmedetomidine on preanesthetic sedation and postoperative recovery profile in children.Settings and Design:Randomized controlled trial.Materials and Methods:We performed a prospective, randomized, controlled study in 60 children, aged 1-7 years undergoing elective, minor, lower abdominal surgeries under general anesthesia. Patients were randomly assigned to receive either oral midazolam 0.75 mg/kg (Group M, n = 30) or oral dexmedetomidine 4 μg/kg (Group D, n = 30) 40 min prior to mask induction. Preoperative sedation and anxiolysis, the response at parental separation, quality of mask acceptance and recovery profile were compared for the two groups.Statistical Analysis Used:Results were analyzed using unpaired Student's t-test and Chi-squared test. P < 0.05 was considered statistically significant.Results:There was no significant difference in the levels of preoperative sedation and anxiolysis between the two groups, but the onset of sedation was significantly faster with midazolam (18.90 ± 3.68 min) than with dexmedetomidine (30.50 ± 4.44 min). Response to parental separation and quality of mask acceptance was comparable between two groups (P > 0.05). The incidence of postoperative agitation was significantly less in the dexmedetomidine group (P < 0.05).Conclusions:In this study, premedication with oral dexmedetomidine produced equally effective preoperative sedation and a better recovery from anesthesia in children in comparison to oral midazolam.

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

“…Sheta et al reported that incidence of agitation after the administration of 1 μg/kg intranasal dexmedetomidine as premedication was lower than that obtained after 0.2 mg/kg intranasal midazolam in children undergoing full-mouth dental rehabilitation [21]. Jannu et al compared the effect of administering 4 μg/kg of oral dexmedetomidine as premedication with that of administering 0.75 mg/kg of oral midazolam and observed a low incidence of agitation in children premedicated with dexmedetomidine [22]. Jannu preoperative oral administration of 4 μg/kg dexmedetomidine or oral administration of 0.75 mg/kg midazolam decreases the incidence of agitation in children aged 1-7 years [23].…”

Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

“…1,4 Because of its amnestic and anxiolytic properties, midazolam, a GABA A agonist, is the drug most frequently used for paediatric premedication. 5,6 Dexmedetomidine is a highly selective a-2 adrenergic agonist with both sedative and analgesic effects via actions in the CNS. 5,6 Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces a state of sedation, anaesthesia, immobility, analgesia, and amnesia.…”

“…5,6 Dexmedetomidine is a highly selective a-2 adrenergic agonist with both sedative and analgesic effects via actions in the CNS. 5,6 Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces a state of sedation, anaesthesia, immobility, analgesia, and amnesia. 7,8 Sedative premedication in children is commonly administered via the oral, rectal, sublingual, and intranasal routes with varying degrees of patient acceptance.…”

The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures

“…Sheta et al reported that the administration of 1 μ g/kg of intranasal DEX as premedication resulted in a lower incidence of ED compared to 0.2 mg/kg of intranasal midazolam in children undergoing full-mouth dental rehabilitation [ 18 ]. Jannu et al compared the effect of administering 4 μ g/kg of oral DEX as premedication to 0.75 mg/kg of oral midazolam and they observed a lower incidence of ED in children premedicated with DEX [ 33 ]. In a similar study, Prabhu and Mehandale reported that 4 μ g/kg of oral DEX was superior to oral midazolam when given as premedication in reducing the incidence and severity of ED [ 34 ].…”