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A Placebo-Controlled Randomized Trial Comparing Oral Midazolam, Dexmedetomidine, and Gabapentin on Prophylaxis of
Mohammad Fouad Algyar1, Ahmed Mohammed Abdelghany2, Sherif Kamal Arafa1
1Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Insights
Oral midazolam, dexmedetomidine (DEX), and gabapentin effectively reduced emergence agitation in pediatric patients after sevoflurane anesthesia. DEX demonstrated superior sedation and hemodynamic control compared to midazolam and gabapentin.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Pharmacology
Background:
- Emergence agitation (EA) affects up to 80% of pediatric patients recovering from sevoflurane anesthesia.
- Effective strategies to mitigate EA are crucial for pediatric post-anesthesia care.
Purpose of the Study:
- To evaluate the prophylactic efficacy of oral midazolam, dexmedetomidine (DEX), and gabapentin in reducing EA incidence in pediatric patients.
- To compare the effects of these premedications on EA severity, extubation time, hemodynamics, and sedation levels.
Main Methods:
- A randomized controlled trial involving 240 pediatric patients aged 3-10 years undergoing adenotonsillectomy.
- Patients received oral midazolam (0.5 mg/kg), DEX (4 µg/kg), gabapentin (10 mg/kg), or placebo 30 minutes before anesthesia.
- Incidence and severity of EA, extubation time, hemodynamics, and sedation scores were assessed.
Main Results:
- All premedications (midazolam, DEX, gabapentin) significantly reduced EA incidence and severity compared to placebo.
- DEX showed a lower EA incidence than midazolam or gabapentin and provided superior sedation and hemodynamic stability.
- Premedication prolonged extubation time but improved hemodynamic parameters and sedation scores.
Conclusions:
- Oral midazolam, DEX, and gabapentin are effective in preventing emergence agitation in pediatric patients post-sevoflurane anesthesia.
- Dexmedetomidine offers the most favorable profile regarding sedation and hemodynamic management.
- Further research with larger sample sizes and longer follow-up is warranted.
Background:
Sevoflurane causes emergence agitation (EA) in up to 80% of pediatric patients.
Objectives:
Using midazolam, dexmedetomidine (DEX), and gabapentin, this work aimed to assess the prophylactic effect of oral premedication on EA incidence experienced by pediatric patients during recovery from sevoflurane anesthesia.
Study Design:
Randomized controlled trial.
Setting:
Kafrelsheikh University, Kafrelsheikh, Egypt.
Methods:
This study was performed on 240 men and women aged 3 to 10 years who were scheduled for adenotonsillectomy. Patients were randomized into 4 equal-sized groups. Thirty minutes before general anesthesia, oral premedication was applied in the form an apple-flavored sugary fluid plus 0.5 mg/kg of midazolam in Group M, 4 µg/kg of DEX in Group D, 10 mg/kg of gabapentin in Group G, or no drugs whatsoever in Group P (placebo).
Results:
The incidence of EA was reduced more greatly in the M, D, and G groups than in the P group, and the D group's incidence of EA was lower than that of the M or G groups. The severity of EA exhibited a more significant reduction in the M, D, and G groups than in Group P. Similarly, the time until extubation was more prolonged in the M, D, and G groups than it was in the P group. Hemodynamics measurements were significantly lower in Groups M, D, and G than in Group P, and the D group had a lower hemodynamics measurement than did the M or G groups. Sedation scores were greater in the D and G groups than in the P group, and the D group had a higher sedation score than did Group M.
Limitations:
This study used a small sample, took place at a single center, and had a short follow-up period.
Conclusion:
Premedication using oral midazolam, DEX, or gabapentin reduced the incidence of EA, and DEX provided the best sedation and hemodynamics of all.
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