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A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Martin Jöhr1

  • 1Paediatric Anaesthesia, Luzerner Kantonsspital, Luzern Switzerland.

Current Opinion in Anaesthesiology
|February 6, 2023
PubMed

Insights

Recent advances in pediatric anesthesia highlight the distinct roles of midazolam and dexmedetomidine for sedation and anxiety. New data also refines propofol dosing for pediatric patients.

Area of Science:

  • Pediatric Anesthesia
  • Pharmacology
  • Sedation and Anxiolysis

Background:

  • Recent developments in pediatric anesthesia have shown an undulating progression.
  • Pharmacological premedication strategies are being reevaluated for efficacy and safety.

Approach:

  • This review examines the defined anxiolytic and sedative properties of midazolam and alpha-2 agonists.
  • It also assesses total intravenous anesthesia with propofol and alternative approaches for preventing emergence agitation.
  • The theoretical basis for propofol dosing has been updated, challenging previous assumptions about its context-sensitive half-life.

Key Points:

  • Midazolam is an effective anxiolytic, while dexmedetomidine offers superior sedation, particularly in the postoperative period and for diagnostic imaging.
  • While total intravenous propofol is common for emergence agitation, co-medication with dexmedetomidine or opioids are viable alternatives.
  • A multimodal approach to anesthesia is often advisable in clinical practice.

Conclusions:

  • Midazolam and dexmedetomidine are not interchangeable; each has unique benefits.
  • Midazolam remains a valuable anxiolytic, whereas dexmedetomidine excels in sedation and postoperative care.
  • Emerging data will enable more precise, age-adapted propofol dosing in pediatric patients.
Abstract

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