Comparison of Oral Clonidine, Oral Dexmedetomidine, and Oral Midazolam for Premedication in Pediatric Patients Undergoing Elective Surgery

Abstract

Background: Midazolam has been commonly used orally for premedication in children. A search for a better alternative continues to overcome its side effects. Recently alpha-2 agonists, clonidine, and dexmedetomidine have been used for premedication in children.

Aim: To study and compare the efficacy of oral clonidine, oral dexmedetomidine, and oral midazolam for premedication in pediatric surgical patients.

Settings and design: This prospective, randomized, double blind study was conducted in a tertiary care hospital.

Materials and methods: The study was conducted in ninety children of either sex, in the age group of 4-12 years and the American Society of Anesthesiologists Physical status I, posted for ophthalmic surgery. Patients were randomly allocated to one of the three groups of thirty patients each: Group M: Oral midazolam 0.5 mg/kg body weight, Group D: Oral dexmedetomidine 4 μg/kg body weight, and Group C: Oral clonidine 4 μg/kg body weight. Patients were assessed for sedation, anxiolysis, and change in heart rate and blood pressure in the preoperative area. Behavior of children at separation from parents, mask acceptance, and side effects if any were noted. Statistical Analysis:: Data analysis was performed by unpaired Student's t-test and Chi-square test. Results:: Children in oral midazolam group achieved faster onset of sedation, higher sedation score, and lower anxiety score as compared to other two groups. The Group D and Group M were comparable as regards behavior at separation from parents (P = 0.236), but Group D was significantly better than Group C (P = 0.031). The three groups were comparable as regards providing satisfactory mask acceptance (P = 0.163). A number of children with easy separation from parents and excellent mask acceptance were significantly more in Group M as compared to Groups C and D (P = 0.028 and P = 0.012, respectively). Group C and Group D showed a lower mean arterial pressure at 45 min (P < 0.001) and 60 min after premedication (P < 0.001) as compared to Group M. Conclusion:: Oral midazolam is superior to the oral clonidine, and oral dexmedetomidine with faster onset of sedation, higher sedation score, lower anxiety score, and greater number of children with easy separation and excellent mask acceptance.

Keywords: Clonidine; dexmedetomidine; midazolam; pediatric; premedication.

Figure 1

Parent separation anxiety score. Data are expressed as percentage of patients. PSAS: Parental separation anxiety score, C: Clonidine, D: Dexmedetomidine, M: Midazolam.

Figure 2

Mask acceptance score. Data are expressed as percentage of patients. C: Clonidine, D: Dexmedetomidine, M: Midazolam, MAS: Mask acceptance score.

Figure 3

Preoperative heart rate at different time intervals. Data are expressed as mean values in beats/min. HR: Heart rate, C: Clonidine, D: Dexmedetomidine, M: Midazolam.

Figure 4

Preoperative mean arterial pressure at different time intervals. Data are expressed as mean values in mmHg. MAP: Mean arterial pressure, C: Clonidine, D: Dexmedetomidine, M: Midazolam.