Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction.

Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg ⁻¹, Group D with intranasal dexmedetomidine 2 μg kg ⁻¹, and Group M + D with intranasal dexmedetomidine 1 μg kg ⁻¹ plus oral midazolam 0.5 mg kg ⁻¹. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time.

Results: Subjects in Group M + D showed higher satisfaction scores of compliance ( p = 0.0049) and mask acceptance (MAS) ( p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level ( p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration ( p < 0.001).

Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg ⁻¹ plus oral midazolam 0.5 mg kg ⁻¹ had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

Related collections

Most cited references 40

Record: found
Abstract: found
Article: not found

Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

Zeev Kain, Alison Caldwell-Andrews, Inna Maranets … (2004)

Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

0 comments Cited 141 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Distress during the induction of anesthesia and postoperative behavioral outcomes.

Siying Wang, M Hofstadter, L Caramico … (1999)

We determined whether children who are extremely anxious during the induction of anesthesia are more at risk of developing postoperative negative behavioral changes compared with children who appear calm during the induction process. Children (n = 91) aged 1-7 yr scheduled for general anesthesia and elective outpatient surgery were recruited. Using validated measures of preoperative anxiety and postoperative behaviors, children were evaluated during the induction of general anesthesia and on Postoperative Days 1, 2, 3, 7, and 14. Using a multivariate logistic regression model, in which the dependent variable was the presence or absence of postoperative negative behavioral changes and the independent variables included several potential predictors, we demonstrated that anxiety of the child, time after surgery, and type of surgical procedure were predictors for postoperative maladaptive behavior. The frequency of negative postoperative behavioral changes decreased with time after surgery, and the frequency of negative postoperative behavioral changes increased when the child exhibited increased anxiety during the induction of anesthesia. Finally, we found a significant correlation (r) of 0.42 (P = 0.004) between the anxiety of the child during induction and the excitement score on arrival to the postanesthesia care unit. We conclude that children who are anxious during the induction of anesthesia have an increased likelihood of developing postoperative negative behavioral changes. We recommend that anesthesiologists advise parents of children who are anxious during the induction of anesthesia of the increased likelihood that their children will develop postoperative negative behavioral changes such as nightmares, separation anxiety, and aggression toward authority. Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an increased likelihood of developing postoperative negative behavioral changes.

0 comments Cited 73 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy.

Sevgi Ors, Z Tosun, Adem Boyaci … (2005)

Dexmedetomidine has shown sedative, analgesic, and anxiolytic effects after intravenous (IV) administration. Sevoflurane is associated with a high incidence of emergence agitation in preschool children. In this placebo-controlled study, we examined the effect of single dose dexmedetomidine on emergence agitation in children undergoing adenotonsillectomy. In a double-blinded trial, 60 children (age 3-7 years) were randomly assigned to receive dexmedetomidine 0.5 microg.kg(-1) IV or placebo, 5 min before the end of surgery. All patients received a standardized anesthetic regimen. For induction and maintenance of anesthesia we used sevoflurane. After surgery, the incidence and severity of agitation was measured 2 h postoperatively. The incidence of untoward airway events after extubation, such as breath holding, severe coughing, or straining were recorded. After surgery, the children's behavior and pain were assessed with a 5-point scale. The agitation and pain scores in the dexmedetomidine group were better than those in the placebo group (P < 0.05). The incidence of severe agitation (a score of 4 or more), and severe pain (a score of 3 or more) were significantly less in the dexmedetomidine group (P < 0.05). The number of severe coughs per patient in the dexmedetomidine group was significantly decreased compared with the control group (P < 0.05). Postoperative vomiting was similar in both groups. Times to emergence and extubation were significantly longer in the dexmedetomidine group (P < 0.05). We conclude that 0.5 microg.kg(-1) dexmedetomidine reduces agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy.

0 comments Cited 68 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Jun Li: URI : https://loop.frontiersin.org/people/1215928/overview

Hua-Cheng Liu: URI : https://loop.frontiersin.org/people/715448/overview

Journal

Journal ID (nlm-ta): Front Pharmacol

Journal ID (iso-abbrev): Front Pharmacol

Journal ID (publisher-id): Front. Pharmacol.

Title: Frontiers in Pharmacology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1663-9812

Publication date (Electronic): 15 December 2021

Publication date Collection: 2021

Volume: 12

Electronic Location Identifier: 648699

Affiliations

[ ¹ ]Department of Anesthesiology, Perioperative and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Anesthesiology of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

[ ² ]Department of Anesthesiology, Cincinnati Children’s Hospital, Cincinnati, OH, United States

Author notes

Edited by: Alfredo Vannacci, University of Florence, Italy

Reviewed by: Jonathan Burton Wagner, Children’s Mercy Hospital, United States

Niccolò Lombardi, University of Florence, Italy

^*Correspondence: Junzheng Wu, Junzheng.wu@ 123456cchmc.org ; Hua-Cheng Liu, huachengliu@ 123456163.com

[ † ]

These authors have contributed equally to this work

This article was submitted to Obstetric and Pediatric Pharmacology, a section of the journal Frontiers in Pharmacology

Article

Publisher ID: 648699

DOI: 10.3389/fphar.2021.648699

PMC ID: 8714926

PubMed ID: 34975463

SO-VID: 8d6cad54-02af-407b-b278-6331a1e2d384

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

Read this article at

Abstract

Related collections

Drug Repurposing Research Collection

Most cited references 40

Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

Distress during the induction of anesthesia and postoperative behavioral outcomes.

Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 152

Cited by 4

Most referenced authors 456