Comparison of Efficacy of Premedication between Dexmedetomidine and Midazolam Intranasal for the Prevention of Emergence Delirium in Children Undergoing Ophthalmic Surgery

Objective: Emergence delirium (ED) is a condition that can occur when a child recovers from anaesthesia uncomfortably. ED can potentially injure children and indirectly discomforts parents. Various interventions were carried out to reduce ED, but there is no specific standard that has been established to prevent ED. Dexmedetomidine and midazolam are said to be effective in reducing ED. This study aims to determine the effectiveness of intranasal dexmedetomidine premedication compared to intranasal midazolam to prevent ED in children undergoing eye surgery. Methods: This study was a double-blinded randomised clinical trial. Paediatric patients aged 1-12 years with physical status ASA 1 and 2 who underwent eye surgery under general anaesthesia using sevoflurane inhalation were included in the study. There were 64 children obtained by consecutive sampling who underwent eye surgery in our institution between February and May 2019. The subjects were then randomised into the dexmedetomidine group and the midazolam group. Effectiveness was assessed from ED events, recovery time and post-premedication desaturation events. Data analysis was performed using Chi-square test and Mann-Whitney test. Results: ED incidence in the dexmedetomidine group was 11.18% compared to 28.12% in the midazolam group (P = .109). The recovery time was found to be at a median of 6 minutes for both groups, and no desaturation was found in either group. Conclusion: There is statistically no significant difference between the effectiveness of intranasal dexmedetomidine and midazolam premedication 30 minutes before induction to prevent ED occurrence in children undergoing eye surgery.