Comparison of sublingual midazolam and dexmedetomidine for premedication in children

Abstract

Background: Premedication in children scheduled for surgery reduces preoperative anxiety and facilitates a smooth induction of anesthesia. Midazolam is a commonly used premedication in children but, because of its undesirable effects such as postoperative behavior changes and cognitive impairment, it is not an ideal premedicant. Dexmedetomidine, a highly specific a2-adrenergic receptor agonist, produces sedation which mimics natural stage 2 non-rapid eye movement sleep and helps in early postoperative recovery. The objective of our study was to evaluate the effectiveness of sublingual dexmedetomidine in comparison to sublingual midazolam as premedicant in children

Methods: This prospective, randomized, double-blind study enrolled 100 children aged 1 to 12 years belonging to ASA physical status I or II scheduled to undergo inguinal hernia repair, orchidopexy or circumcision, under general anesthesia. The children were randomly allocated into two groups of 50 each. Children in group I were premedicated with sublingual midazolam 0.25 mg/kg, while those in group II with sublingual dexmedetomidine 1.5 µg/kg. Sedation was assessed using a 6-point sedation score. Behavior at induction, wake-up behavior and mask acceptance was evaluated using a 4-point scoring system.

Results: The median sedation score at parental separation was 6 in group I as compared to 3.5 in group II (P<0.001). The behavior score at induction was comparable in both the groups. The median mask acceptance score (P<0.001) and wake-up behavior score (P=0.001) in preschool children was 2 in group I as compared to 1 in group II. However, in school-aged children both the scores were comparable.

Conclusion: Sublingual dexmedetomidine provides more effective preoperative sedation as compared to sublingual midazolam across all the age groups and allows a smooth anesthesia induction and awakening especially in the preschool children.