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Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing
Åsa Bromfalk1, Magnus Hultin2, Jakob Walldén3
1Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden.
Insights
Clonidine and dexmedetomidine offer deeper sedation than midazolam for pediatric surgery. All three sedative premedications maintained stable cardiorespiratory status in children during the perioperative period.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Critical Care Medicine
Background:
- Sedative premedication in children can impact perioperative cardiorespiratory status.
- Optimal premedication strategies for pediatric surgical patients remain unclear.
- Preschool children undergoing surgery require careful consideration of sedation effects.
Purpose of the Study:
- To compare perioperative cardiorespiratory responses to three sedative premedication regimens in preschool children.
- Evaluate the efficacy of oral midazolam, oral clonidine, and intranasal dexmedetomidine.
- Assess sedation levels and cardiorespiratory stability during anesthesia.
Main Methods:
- Single-center randomized controlled trial with 83 children aged 2-6 years.
- Comparison of oral midazolam (MID), oral clonidine (CLO), and intranasal dexmedetomidine (DEX).
- Monitoring of sedation (Ramsay Sedation Scale) and cardiorespiratory parameters (heart rate, respiratory rate).
Main Results:
- Clonidine and dexmedetomidine provided deeper preoperative sedation than midazolam (lower RSS scores).
- Heart rate was significantly lower in the clonidine and dexmedetomidine groups compared to midazolam.
- Respiratory rate was lowest in the dexmedetomidine group before anesthesia induction.
Conclusions:
- Clonidine and dexmedetomidine are more effective sedatives preoperatively than midazolam in preschool children.
- All three premedication regimens (midazolam, clonidine, dexmedetomidine) ensured stable cardiovascular and respiratory conditions.
- These findings aid in selecting appropriate sedative premedication for pediatric surgical patients.
Purpose:
Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.
Design:
A single-center randomized controlled trial.
Methods:
This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2-6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg-1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.
Findings:
The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min-1, CLO 20.6±2.6 min-1, DEX 20.2±1.7 min-1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min-1; CLO, 87.4±9.6 min-1; DEX, 87.6±7.9 min-1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.
Conclusions:
When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.
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