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Intranasal Fentanyl, Midazolam and Dexmedetomidine as Premedication in Pediatric Patients

Veena Chatrath1, Rajan Kumar1, Upasna Sachdeva1

  • 1Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.

Anesthesia, Essays and Researches
|October 5, 2018
PubMed

Insights

Intranasal fentanyl and midazolam offer faster sedation for pediatric surgery than dexmedetomidine. Fentanyl excels in induction and IV cannulation, while dexmedetomidine provides superior postoperative sedation.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology

Background:

  • Pediatric patients experience significant stress during surgery.
  • Pharmacologic premedication is crucial for managing pediatric anxiety and facilitating anesthesia induction.
  • Limited cognitive abilities in children heighten their susceptibility to surgical stress.

Purpose of the Study:

  • To compare the efficacy of intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients.
  • To evaluate the onset of action, anxiolysis, sedation, and procedural outcomes associated with these agents.

Main Methods:

  • Prospective study of 75 pediatric patients (2-6 years, ASA Class I/II).
  • Patients divided into three groups receiving intranasal fentanyl (1.5 μg/kg), midazolam (0.3 mg/kg), or dexmedetomidine (1 μg/kg) 50 minutes pre-surgery.
  • Outcomes assessed included anxiolysis, sedation, child-parent separation, induction quality, IV cannulation, and postoperative sedation.

Main Results:

  • Intranasal fentanyl and midazolam demonstrated earlier onset of anxiolysis and sedation compared to dexmedetomidine.
  • Fentanyl and dexmedetomidine improved child-parent separation and induction quality over midazolam.
  • Fentanyl yielded the best results for intravenous cannulation, while dexmedetomidine provided prolonged postoperative sedation.

Conclusions:

  • Fentanyl and midazolam have a faster onset of action than dexmedetomidine for pediatric premedication.
  • Fentanyl offers superior conditions for surgical induction and emergence.
  • Dexmedetomidine's delayed onset and prolonged action are beneficial for sustained postoperative calmness and sedation.
Abstract

Keywords:
Dexmedetomidinefentanylintranasal premedicationmidazolam

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