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Comparison of sublingual midazolam and dexmedetomidine for premedication in children

D Pant1, N Sethi, J Sood

  • 1Department of Anesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India - nitinsethi77@yahoo.co.in.

Minerva Anestesiologica
|July 24, 2013
PubMed

Insights

Sublingual dexmedetomidine offers superior preoperative sedation in children compared to midazolam, ensuring smoother anesthesia induction and recovery, particularly for preschoolers. This study highlights its effectiveness in pediatric surgical settings.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Surgical Premedication

Background:

  • Premedication reduces preoperative anxiety and aids anesthesia induction in children.
  • Midazolam, a common pediatric premedicant, has drawbacks like postoperative behavioral changes.
  • Dexmedetomidine, a selective alpha-2 adrenergic agonist, offers sedation mimicking natural sleep and aids recovery.

Purpose of the Study:

  • To compare the effectiveness of sublingual dexmedetomidine versus sublingual midazolam as a premedicant in pediatric patients.
  • To evaluate sedation levels, induction behavior, mask acceptance, and wake-up behavior.

Main Methods:

  • Prospective, randomized, double-blind study of 100 children (1-12 years, ASA I/II).
  • Group I received sublingual midazolam (0.25 mg/kg); Group II received sublingual dexmedetomidine (1.5 µg/kg).
  • Assessed sedation, induction behavior, mask acceptance, and wake-up behavior using standardized scores.

Main Results:

  • Dexmedetomidine group showed significantly lower sedation scores at parental separation (3.5 vs. 6, P<0.001).
  • Preschoolers exhibited better mask acceptance and wake-up behavior with dexmedetomidine (scores of 1 vs. 2, P<0.001).
  • Behavior at induction was comparable; scores were similar in school-aged children.

Conclusions:

  • Sublingual dexmedetomidine is more effective for preoperative sedation than sublingual midazolam in children.
  • Dexmedetomidine facilitates smoother anesthesia induction and awakening, especially in preschool-aged children.
  • Offers a potentially improved alternative to midazolam for pediatric surgical premedication.
Abstract

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