Comparison of either separated or combined intranasal dexmedetomidine
and oral midazolam on anesthesia inhalation induction in children
Abstract
Abstract Background and Purpose: Anesthetic inhalation induction could
be one of the most stressful experiences for children. While, either
oral midazolam or nasal dexmedetomidine as premedication remains less
than ideal. This study was to assess the efficacy and safety when those
two premeds were applied together in children undergoing minor
surgeries. Experimental Approach: One hundred and thirty-eight children
aged 2-6 years old were randomly allocated into three equal groups based
on the premedication routes: Group M with oral midazolam 0.5 mg.kg-1,
Group D with intranasal dexmedetomidine 2 μg.kg-1 and Group MD with
intranasal dexmedetomidine 1 μg.kg-1 plus oral midazolam 0.5 mg.kg-1,
respectively. The primary outcome was the satisfactory compliance rate
during inhalation induction with sevoflurane using induction compliance
checklist. The secondary outcomes were the preoperative m-YPAS scores
when the children arrived in the holding area, sedation level, behavior
scores, parental separation anxiety scores, mask acceptance scale (MAS),
the incidence of emergence agitation, recovery time and other adverse
events. Key Results: Subjects in Group MD showed higher satisfactory
compliance rate (n=38, P=0.0049) and satisfactory MAS (n=38, P=0.0049)
on anesthesia inhalation induction. Compared to the Group M and D,
Subjects in Group MD had significantly shorter onset time to achieve the
satisfactory sedation level (P<0.001) and higher sedation
score at 20 and 30min after drug administration (P<0.001).
Conclusion and Implications: We conclude that combined intranasal
dexmedetomidine 1μg.kg-1 and oral midazolam 0.5 mg.kg-1 significantly
improved the compliance during inhalation induction with sevoflurane,
and had quicker onset to reach satisfactory sedation level in children.