A Comparative Evaluation of Intranasal Dexmedetomidine and Intranasal Midazolam for Premedication in Pediatric Surgery

Background: We sought to compare the effects of intranasal Dexmedetomidine a more selective alpha 2 receptor with the effects of Midazolam administered via the same route Materials and methods: After approval by hospital research ethics committee, informed written parental consent for anesthesia was taken. 60 patients with ASA grade I or II in age group (2-9 years) were enrolled for this. The study was carried out from February 2014 to May 2015 in a tertiary care hospital. For the study, 60 patients were divided in two groups: Group M: 0.2 mg/kg intranasal Midazolam and Group D: 1 µg/kg intranasal Dexmedetomidine. All patients in either group have received general anaesthesia using a standard balance anesthesia technique. Comparisons between the study groups were conducted using ANOVA by using multivariate ANOVA test, one-way ANOVA test, repeated measures ANOVA and Kruskal–Wallis ANOVA test as well as comparing mean and standard deviation. Results: Our study demonstrated that intranasal Dexmedetomidine produces better sedation than intranasal Midazolam in pediatric age group. Ease of parent child separation at 30 minutes was satisfactory in group D though group M offered less satisfactory ease of parent child separation. In our study, the changes in heart rate and systolic blood pressure in group M and group D were clinically insignificant and modest. There were no episodes of significant bradycardia, hypotension, bradypnoea, apnea, airway obstruction, emesis and arterial oxygen desaturation at any time during the study. None of the children were sedated to the extent that they failed to respond to stimulation or were unarousable. Ease of induction after 30 minutes was better in group D compared to group M. Conclusion: Dexmedetomidine, in a dose of 1 microgram/ kg administered intranasally produces better sedation, better parental separation and mask acceptance as compared with intranasal Midazolam 0.2 mg/kg. The hemodynamic change produced with Dexmedetomidine are clinically insignificant (<20% of baseline) and modest.