Comparison of intranasal dexmedetomidine and midazolam as premedication in pediatric surgical patients: A prospective, randomized double-blind study

Diwan, Gayendra; Bharti, A.; Rastogi, Kapil; Gupta, Pramod

doi:10.4103/aer.aer_102_20

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…According to the analysed studies, intranasal dexmedetomidine has a better initiation of sedation during the initial phases of the suture procedure (positioning of the child, washing the wound) than intranasal midazolam; however, no significant differences were found for the rest of the procedure, recovery or the time elapsed until discharge from the hospital [10]. However, other clinical trials have shown significant differences in favour of intranasal dexmedetomidine in children (dose 1 µg/kg), which produces a greater reduction in anxiety and a better level of sedation than intranasal midazolam (dose 0.2 mg/kg) without adverse effects or nasal irritation or burning [36][37][38]; therefore, it may be preferable to midazolam. However, other studies have shown that the time to the initiation of sedation was longer with intranasal dexmedetomidine than with intranasal midazolam [13,[38][39][40] and it produced longer-lasting sedation [13].…”

Section: Other Sedative Drugsmentioning

confidence: 96%

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review

et al. 2022

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Objective: The objective of this study was to evaluate the efficacy and safety of intranasal midazolam as part of a paediatric sedation and analgesic procedure during the suturing of traumatic lacerations in paediatric emergency departments. Methodology: A systematic review of clinical trials was completed in July 2021. The databases consulted were PUBMED, SCOPUS, WEB OF SCIENCE, NICE and Virtual Health Library. Eligibility criteria: randomised and nonrandomised clinical trials. Two independent, blinded reviewers performed the selection and data extraction. The participants were 746 children, of whom, 377 received intranasal midazolam. All of the children were admitted to an emergency department for traumatic lacerations that required suturing. The quality of the articles was evaluated with the Jadad scale. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Nine studies were included in the review. The intranasal administration of midazolam in healthy children produces anxiolysis and minimal/moderate sedation without serious side effects. Although there are combinations of parenteral drugs that produce deeper sedation, they also have greater adverse effects. No significant differences in the initiation of sedation and the suture procedure were found between the intranasal route and the parenteral route. Conclusions: The use of intranasal midazolam in healthy children produces sufficiently intense and long-lasting sedation to allow for the suturing of traumatic lacerations that do not present other complications; therefore, this drug can be used effectively in paediatric emergency departments.

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Section: Other Sedative Drugsmentioning

confidence: 96%

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review

et al. 2022

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A comparative evaluation of intranasal α2-adrenoceptor agonists and intranasal midazolam as premedication in pediatric sedation: A meta-analysis of randomized controlled trials

Zhang

Jiang

et al. 2023

PLoS ONE

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Background Midazolam and α2-adrenoceptor agonists have been widely used off-label as intranasal sedatives for children. The present meta-analysis aimed to evaluate the effects of two interventions in pediatric sedation. Methods PubMed, Embase, and Cochrane Library were searched from inception to April 2022. All randomized controlled trials used intranasal α2-adrenoceptor agonists and midazolam as sedatives in children were enrolled. Parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as outcomes. Results Totally 21 studies with 1,495 patients were included. Only one study reported comparison between midazolam and clonidine met the inclusion criteria, and patients in clonidine group had significantly better mask acceptance compared to midazolam group. Compared with midazolam, using of dexmedetomidine was associated with higher rate of satisfactory parental separation (52.88% vs 75.18%, RR = 0.70, with 95%CI [0.55, 0.90]), anesthesia induction or facemask acceptance (60.92% vs 81.47%, RR = 0.76, 95% CI [0.68, 0.84]) and less incidence of postoperative pain and nasal irritation. Conclusion Compared with midazolam, dexmedetomidine should be considered as the preferred intranasal sedative option for pediatric patients, since it provides more satisfactory sedative level with less incidence of several side effects. But insufficient evidences about effects of intranasal clonidine and overall low and moderate quality evidences evaluated by GRADE system indicate that superiority of intranasal α2-adrenoceptor agonists in pediatric sedation needs to be validated by more studies with high quality and large sample size in future.

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A comparative study of intranasal dexmedetomidine and intranasal midazolam for premedication - A prospective randomized double-blind study in children posted for tonsillectomy

Nagarajan

Sekar²,

Srinivasan³

et al. 2022

IJCA

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Preanesthetic medication in paediatric patients is well known to be a challenge for anaesthesiologists. Premedication in paediatric population helps to produce a relaxed state with reduced anxiety and increased compliance as well as to ease separation from parent and allowing the patient to tolerate and co-operate with the necessary procedure. Our aim is to do a comparation of dexmedetomidine and midazolam given via intranasal route in children posted for tonsillectomy as premedication.This study was conducted in 100 patients of 6 to 12 years posted for tonsillectomy. Patients were randomly allocated into Group M and D. Patient in group M (50) received 0.2mg/kg of midazolam administered intranasally as nasal drop using 1ml insulin syringe and similarly group D (50) received 1µg/kg of dexmedetomidine administered intranasally as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, mask induction score, post-operative agitation score was assessed.Satisfactory sedation was achieved by 86% and 68% of patient in dexmedetomidine and midazolam respectively p (0.03). Satisfactory mask induction was achieved by 84% and 70% of patient in dexmedetomidine and midazolam respectively p (0.09). In terms of post op agitation score there is no difference in both the group p (0.30). During the time between administration of pre op drugs and initiation of anaesthesia, no patient seems to develop hypotension, hypoxia or any other life-threatening complicationIn our study we concluded that in terms of decreasing anxiety at parental separation both dexmedetomidine and midazolam were found to be equally effective. However, Intranasal dexmedetomidine produced superior sedation scores at separation and induction compared to oral midazolam in paediatric patients.

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Comparison of intranasal dexmedetomidine and midazolam as premedication in pediatric surgical patients: A prospective, randomized double-blind study

Cited by 5 publications

References 15 publications

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review

A comparative evaluation of intranasal α2-adrenoceptor agonists and intranasal midazolam as premedication in pediatric sedation: A meta-analysis of randomized controlled trials

A comparative study of intranasal dexmedetomidine and intranasal midazolam for premedication - A prospective randomized double-blind study in children posted for tonsillectomy

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