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Comparison between dexmedetomidine and midazolam premedication in pediatric patients undergoing ophthalmic day-care
Shailesh Bhadla1, Deepal Prajapati1, Thaju Louis1
1Department of Anesthesiology, Byramjee Jeejeebhoy Medical College, Civil Hospital, Ahmedabad, Gujarat, India.
Insights
Dexmedetomidine offers superior pediatric premedication compared to Midazolam, providing better sedation, parent separation, and reduced postoperative agitation. This study highlights its effectiveness in anesthesia induction.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Pharmacology
Background:
- Midazolam is a common pediatric premedication for reducing anxiety and improving anesthesia induction.
- Dexmedetomidine, a selective alpha-2 agonist, presents an alternative with potentially improved pharmacokinetic properties over clonidine.
Purpose of the Study:
- To compare the efficacy and safety of intravenous Dexmedetomidine versus Midazolam as premedication in pediatric patients undergoing anesthesia.
Main Methods:
- An open-label, single-blind study involving 60 pediatric patients randomly assigned to receive either Dexmedetomidine (0.4 μg/kg IV) or Midazolam (0.05 mg/kg IV).
- Key parameters assessed included sedation levels, parent separation, response to induction, hemodynamic stability (blood pressure, pulse, oxygen saturation), and postoperative outcomes (agitation, shivering).
Main Results:
- Dexmedetomidine group showed significantly higher sedation levels (P<0.001), better parental separation acceptance, and improved response to induction compared to the Midazolam group.
- Postoperative agitation and shivering were significantly lower in the Dexmedetomidine group.
- Hemodynamic parameters (blood pressure, pulse) were slightly lower in the Dexmedetomidine group, but oxygen saturation remained comparable between groups without statistical significance.
Conclusions:
- Intravenous Dexmedetomidine is superior to Midazolam for pediatric premedication, offering enhanced sedation, superior parent separation, and favorable induction conditions.
- Dexmedetomidine demonstrates a lower incidence of postoperative agitation and shivering, alongside maintained hemodynamic stability and no respiratory depression, making it a preferred choice.
Unlabelled:
Midazolam is the most commonly used premedication in children. It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an a2 agonist, has been suggested as an alternative. Dexmedetomidine is a more a2 selective drug with more favorable pharmacokinetic properties than clonidine.
Aims:
To compare i.v. Dexmedetomidine and Midazolam as premedication in pediatric patients.
Settings And Design:
Open label single blind study.
Material And Methods:
60 patients were randomly allocated to group D(n=30) and group M(n=30) and given Inj Dexmedetomidine 0.4 μg/kg diluted in 10 ml slowly i.v. and Inj Midazolam 0.05mg/kg i.v. accordingly. Level of sedation, parent separation, response to induction, blood pressure, pulse, oxygen saturation, post operative agitation and shivering was noted.
Statistical Analysis Used:
Unpaired student's t-test and chi square test used in this study. P value <0.05 was considered significant.
Results:
There were significant differences in parental separation acceptance,Response to induction and wake-up behavior score. When compared with group M, patients in groupD were significantly more sedated % minutes after premedication (P<0.001). Post operative agitation and shivering was low in group D in comparision with group M. Though blood pressure and pulse were on lower side in group D than in group M, oxyden saturation remained same in both the groups having no statistical significance.
Conclusions:
Dexmedetomidine is superior than Midazolam as premedication in pediatric patients with more intense sedation, excellent parent separation, favourable induction conditions, lower incidence of postoperative agitation and shivering along with hemodynamic stability and no respiratory depression.
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