Comparison of intranasal midazolam-fentanyl with dexmedetomidine-fentanyl as pre-medication in the paediatric age group

Abstract

Background & objectives: Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries.

Methods: Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 μg/kg) and group B received intranasal dexmedetomidine (1 μg/kg)-fentanyl (2 μg/kg) 20 min before induction of general anaesthesia. Heart rate and SpO₂ were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher's Facial Pain Scale.

Results: Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher's Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine-fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl.

Interpretation & conclusions: Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Keywords: Dexmedetomidine; fentanyl; intranasal; midazolam; paediatric; pre-medication.