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Preoperative Anxiolytic and Sedative Effects of Intranasal Remimazolam and Dexmedetomidine: A Randomized Controlled

Yu-Hang Cai1, Cheng-Yu Wang1, Yu-Bo Fang1

  • 1Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.

Drug Design, Development and Therapy
|May 22, 2024
PubMed

Insights

Intranasal remimazolam effectively reduces preoperative anxiety in children, offering rapid onset with mild sedation. However, it may cause nasal irritation and cooperation issues.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology

Background:

  • Preoperative anxiety is a significant concern in pediatric surgery.
  • Intranasal administration offers a non-invasive route for sedative medications.
  • Remimazolam, an ultra-short-acting sedative, has limited investigation in pediatric populations.

Purpose of the Study:

  • To evaluate the efficacy of intranasal remimazolam versus dexmedetomidine in alleviating preoperative anxiety in children.
  • To compare the sedative effects and cooperation behaviors associated with these agents.

Main Methods:

  • A randomized controlled trial involving 90 children undergoing general surgery.
  • Three groups received intranasal remimazolam, dexmedetomidine, or distilled water.
  • Outcomes included anxiety scores (m-Ypas), sedation levels, cooperation, parental separation anxiety (PSAS), and mask acceptance (MAS).

Main Results:

  • Intranasal remimazolam significantly reduced anxiety at 10 minutes and during anesthesia induction compared to placebo and dexmedetomidine.
  • Remimazolam induced mild sedation, while dexmedetomidine tended towards deeper sedation.
  • Remimazolam improved mask acceptance and reduced parental separation anxiety but caused nasal irritation and poorer cooperation during administration.

Conclusions:

  • Both intranasal remimazolam and dexmedetomidine are effective in reducing preoperative anxiety in children.
  • Remimazolam offers a rapid onset and mild sedation but is associated with nasal irritation and cooperation challenges.
  • Further research is needed to optimize intranasal remimazolam use in pediatric patients.
Abstract

Keywords:
dexmedetomidinepaediatricspremedicationpreoperative anxietyremimazolam

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