A Comparative Evaluation of Intranasal Dexmedetomidine & Intranasal Midazolam for Pre-Operative Sedation in Children

BACKGROUND Prior to any operative procedure, children are often susceptible to fear & anxiety of being separated from parents & entering the operating room (OR) environment. One of the ways a paediatric anaesthesiologist can deal with this challenge is to sedate the child beforehand. We wanted to compare the efficacy of intranasal dexmedetomidine & intranasal midazolam for preoperative sedation. METHODS Study subjects comprised of children aged 2-8 years posted for elective surgery under general anaesthesia. It was a double-blind randomized control trial comprising of 90 subjects divided into 2 groups. Group A (n=42) received 0.2 mu g/Kg dexmedetomidine & Group B (n=48) 0.5 mg/Kg midazolam by intranasal route 45 minutes prior to induction. Sedation & analgesia scores were assessed by Ramsay Sedation Scale & Observer Pain Scale respectively. Heart rate & systolic blood pressures were recorded every 15 minutes pre-operatively after administration of drugs. Sedation & analgesia scores were recorded at induction, recovery, after 3 hours & 6 hours post operatively. RESULTS 93% subjects in group A & 60% in group B achieved satisfactory sedation at the time of induction. Sedation status & analgesia obtained at the time of induction, recovery, 3 hours & 6 hours post operatively were significantly better in group A. Pre-operative changes in HR & SBP in both groups were comparable. CONCLUSIONS Intranasal dexmedetomidine is safe & more effective than intranasal midazolam for pre-operative sedation in children. Also, intranasal dexmedetomidine is a superior agent than intranasal midazolam for post-operative analgesia in paediatric population.