Pre-anaesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial

Segovia, Benigno Linares; Cuevas, Marco Antonio García; Casillas, I.L. Ramírez; Romero, Jesús Francisco Guerrero; Buenrostro, I. Botello; Monroy-Torres, Rebeca; Gómez, Xóchitl Sofía Ramírez

doi:10.1016/j.anpede.2013.12.003

Cited by 15 publications

(19 citation statements)

References 13 publications

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“…As our center began using intranasal dexmedetomidine for anxiolysis, there were anecdotal successes, which led some providers to feel that it provided superior anxiolysis as compared to midazolam. A review of the current literature supported the anecdotal cases with several studies showing that dexmedetomidine may be superior or comparable to midazolam in terms of anxiolysis …”

Section: Discussionmentioning

confidence: 73%

“…Intranasal dexmedetomidine has been reported to be better accepted by patients than intranasal midazolam . Several studies have demonstrated anxiolysis with dexmedetomidine and compared it to midazolam in the anesthesia, dental, and imaging literature . This is the first study of intranasal dexmedetomidine for procedural anxiolysis in either pediatric or adult emergency medicine literature.…”

mentioning

confidence: 95%

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Double‐blind Randomized Controlled Trial of Intranasal Dexmedetomidine Versus Intranasal Midazolam as Anxiolysis Prior to Pediatric Laceration Repair in the Emergency Department

Neville

Hayes

Ivan

et al. 2016

Academic Emergency Medicine

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Objective: The objective of this study was to compare anxiolysis with intranasal dexmedetomidine, an alpha-2 agonist, versus intranasal midazolam for pediatric laceration repairs. Methods:We performed a double-blind, randomized controlled trial of 40 patients 1-5 years with lacerations requiring suture repair in an academic pediatric emergency department (ED). Patients were randomized to receive either intranasal dexmedetomidine or intranasal midazolam. Our primary outcome measure was the anxiety score at the time of patient positioning for the laceration repair. We chose this time point to isolate the anxiolysis from the medications prior to intervention. Patient encounters were videotaped and scored for anxiety at multiple time points using the modified Yale Preoperative Anxiety Scale. The scale is 23.3-100 with higher scores indicating higher anxiety. We also evaluated these scores as a secondary outcome by dichotomizing them into anxious versus not anxious with a previously validated score cutoff.Results: Of the 40 patients enrolled, 20 in the dexmedetomidine group and 18 in the midazolam group completed the study and were included in the analysis. The median age was 3.3 years (range = 1.0-5.4 years). The median baseline anxiety score was 48.3. The anxiety score at position for procedure for patients receiving dexmedetomidine was 9.2 points lower than those receiving midazolam (median difference = 9.2, 95% confidence interval = 5 to 13.3; median score for dexmedetomidine = 23.3, median score for midazolam = 36.3). The proportion of patients who were classified as not anxious at the position for procedure was significantly higher in the dexmedetomidine group (70%) versus the midazolam group (11%). The number needed to treat with dexmedetomidine instead of midazolam to obtain the result of a not anxious patient at this time point was 1.7 patients. There were also significantly more patients who were classified as not anxious at the time of wound washout in the dexmedetomidine group compared to the midazolam group (35% vs. 6%). Dexmedetomidine and midazolam performed similarly with respect to all other measures including anxiety at other time points, parental perceived anxiety, parent and proceduralist satisfaction, procedural success, complications, and time in the ED. There were no serious adverse events seen in either group.Conclusions: Intranasal dexmedetomidine is an alternative anxiolytic medication to intranasal midazolam for pediatric laceration repairs, performing similarly in our study, except that patients who received dexmedetomidine had less anxiety at the time of positioning for procedure.ACADEMIC EMERGENCY MEDICINE 2016;23:910-917

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 95%

Double‐blind Randomized Controlled Trial of Intranasal Dexmedetomidine Versus Intranasal Midazolam as Anxiolysis Prior to Pediatric Laceration Repair in the Emergency Department

Neville

Hayes

Ivan

et al. 2016

Academic Emergency Medicine

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“…The included articles were undertaken from 2008-2016 in eight different countries: USA (one), Turkey (one), Saudi Arabia (one), India (three), China (three), Egypt (two), Mexico (one), and Oman (one). Four studies 13,18,19,22 compared the effects of intranasal dexmedetomidine with those of oral midazolam, and six studies 10,11,14,16,17,21 compared the effects of intranasal dexmedetomidine with those of intranasal midazolam. One study compared intranasal dexmedetomidine with intranasal clonidine, 15 and two studies compared intranasal dexmedetomidine with intranasal normal saline.…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

“…All of the included studies used a random allocation method. Ten studies [10][11][12][13][14][15][16][17][18]22 described the allocation concealment in detail, and six studies 10,11,13,15,16,22 concretely explained their blinding methods. The risk of allocation concealment and blinding was unclear in the other studies.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis

Jun

Kim

et al. 2017

Can J Anesth/J Can Anesth

101

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“…Dexmedetomidine is a α2-adrenergic receptor agonist that has sedative and analgesic properties (31,32). The intranasal administration of dexmedetomidine before anesthesia has been reported to reduce presurgical anxiety (33). In our study, the administration of dexmedetomidine 30 minutes before surgical incision appeared to attenuate anxiety-like behaviors and persistent pain.…”

Section: Figure 4 Effect Of Dexmedetomidine On the Gr Protein Expresmentioning

confidence: 50%

Dexmedetomidine Alleviates Presurgical Anxiety-Induced Persistent Postsurgical Pain via Decreasing the Expression of Glucocorticoid Receptor

Li¹,

Zhang²,

Yin³

et al. 2018

J Anesth Perioper Med

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Background: Preoperative anxiety can worsen postsurgical pain. Glucocorticoids play an important role in psychological anxiety and pain, but the effect of glucocorticoid receptor (GR) on persurgical anxiety-induced persistent postsurgical pain remains unknown. Methods: Adult male Sprague Dawley rats were randomly divided into 10 groups: control group, SPS group, incision group, 'SPS-plus-incision' group, saline group, metyrapone group, Dexmedetomidine group 1 (10 μg/kg), Dexmedetomidine group 2 (20 μg/kg), Dexmedetomidine group 3 (40 μg/kg) and Dexmedetomidine + Corticosterone group. Single-prolonged stress (SPS) was used to induce anxiety behaviors. Intraperitoneal injection of saline and dexmedetomidine was performed at 24 h after SPS and 0.5 h before incision. Intraperitoneal injection of metyrapone (25 mg/kg) was performed at 1h before SPS. Paw withdrawal mechanical threshold (PWMT) was tested at 24 h before SPS and on 1, 4, 7, 14, 21, and 28 days after incision. Corticosterone levels were determined using ELISA. The expression of GR was determined using Western blot. Results: The 'SPS-plus-incision' group decreased PWMT compared with control group and incision group from 1 to 28 days (P<0.05). SPS combined with incision increased plasma corticosterone levels compared with control group (P<0.05). A timedependent increase in GR was also observed in 'SPS-plus-incision' group (P<0.05). Metyrapone significantly blunted the SPS-induced persistent postsurgical pain (P< 0.05). Intraperitoneal administration of dexmedetomidine inhibits SPS-induced persistent pain compared with group saline (P<0.05). The expression of GR decreased after the intraperitoneal administration of dexmedetomidine (P<0.05). Pretreatment with corticosterone blocked this effect. Conclusions: Glucocorticoids contributed to presurgical anxiety-induced persistent postsurgical pain. Dexmedetomidine that decreased the expression of GR alleviated anxiety-induced persistent pain. These results indicated that dexmedetomidine may be an effective agent for preventing presurgical anxiety-induced persistent postoperative pain.

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Pre-anaesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial

Cited by 15 publications

References 13 publications

Double‐blind Randomized Controlled Trial of Intranasal Dexmedetomidine Versus Intranasal Midazolam as Anxiolysis Prior to Pediatric Laceration Repair in the Emergency Department

Double‐blind Randomized Controlled Trial of Intranasal Dexmedetomidine Versus Intranasal Midazolam as Anxiolysis Prior to Pediatric Laceration Repair in the Emergency Department

The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis

Dexmedetomidine Alleviates Presurgical Anxiety-Induced Persistent Postsurgical Pain via Decreasing the Expression of Glucocorticoid Receptor

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