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Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and
Åsa Bromfalk1, Tomi Myrberg1, Jakob Walldén2
1Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden.
Insights
Midazolam effectively reduced preoperative anxiety in preschool children undergoing surgery, with less sedation compared to clonidine and dexmedetomidine. This finding aids in selecting optimal pediatric premedication for better perioperative management.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Pharmacology
Background:
- Pediatric anxiety poses challenges in perioperative care and can negatively impact outcomes.
- Current sedative options for reducing anxiety in preschool children lack consensus regarding efficacy.
- Effective premedication is crucial for managing anxiety and improving the perioperative experience in young children.
Purpose of the Study:
- To compare the anxiolytic effects of midazolam, clonidine, and dexmedetomidine in preschool children.
- To evaluate the impact of these premedications on distress during IV insertion and compliance during anesthesia induction.
- To assess the level of sedation induced by each premedication in pediatric patients.
Main Methods:
- A double-blinded randomized clinical trial involving 84 preschool children (aged 2-6 years) scheduled for elective surgery.
- Participants received either oral midazolam (0.5 mg/kg), oral clonidine (4 µg/kg), or intranasal dexmedetomidine (2 µg/kg).
- Anxiety, distress, compliance, and sedation were measured using validated scales (e.g., Yale Preoperative Anxiety Scale, Ramsay Sedation Scale).
Main Results:
- Preoperative anxiety levels were similar at baseline across all groups.
- Anxiety increased with clonidine and dexmedetomidine but remained stable with midazolam.
- No significant differences were observed in distress during IV insertion or compliance during anesthesia induction.
- Clonidine and dexmedetomidine groups exhibited higher sedation levels compared to the midazolam group.
Conclusions:
- Midazolam demonstrated superior anxiolysis with less sedation in preschool children compared to clonidine and dexmedetomidine.
- Midazolam may be a preferred premedication for managing preoperative anxiety in this age group.
- These findings contribute to evidence-based selection of sedative agents for pediatric anesthesia.
Introduction:
Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.
Patients And Methods:
In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.
Results:
Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.
Conclusions:
In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
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