Introduction: Children undergoing surgical procedures can experience significant anxiety and distress during perioperative period. Sedation in preoperative room remains one of the widely used methods. Intranasal route is preferred, as it is noninvasive and more convenient.

Aim: To compare the efficacy of intranasal dexmedetomidine and Intranasal midazolam for paediatric premedication.

Method: In this prospective, randomised controlled trial 100 patients of 2 to 9 years of age of either sex belonging to ASA class 1 and 2 Undergoing various elective surgery were divided into two groups. Group-1 received 0.2 mg / kg intranasal midazolam, group-2 received 1mcg/kg Intranasal dexmedetomidine 45-60 minutes prior to induction.Onset ofsedation, degree of sedation, parent separation anxiety scale, acceptance of mask, venipuncture score were assessed.

Results: The mean onset of sedation were higher in Group 2(19.34±4.16 Vs 15.46±5.09) which was statistically significant (P=.001). Mean sedation score were lower in group 2(2.6±0.61 Vs 2.98±0.59) which was statistically Significant (P=0.003). The Mean acceptance of mask score were lower In group 2(1.2±0.49 Vs1.54±0.73) which was statistically significant (P =0.008).The mean venipuncture score were lower in group 2(2.06±0.31 Vs 2.18±0.39) which was Statistically Insignificant (P=0.09).The mean parental separation anxiety scale were lower in group 2 (1.38±0.57 Vs 1.66±0.74) which was statistically significant (P <0.03).

Conclusion: Intranasal dexmedetomidine results in higher sedation level, better parental separation and better acceptance of mask thanintranasal midazolam but has slower onset of action than midazolam. Both the drugs having similar response to cannulation.

1. Singla D, Chaudhary G, Dureja J, Mangla M. Comparison of dexmedetomidine versus midazolam for intranasal premedication in children posted for elective surgery: a double-blind, randomised study. South AfrAnaesthAnalg2015; 21: 154-7.
2. Sinha C, Kaur M, Kumar A, Kulkarni A, Ambareesha M, Upadya M. Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients. J Anaesth Clin Pha Sinha C, Kaur M, Kumar A, Kulkarni A, Ambareesha M, Upadya M. Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients. J Anaesth Clin Pharmacol 2012;28:32-5.
3. Ni J. “Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis”. PLoS One 10.5 (2015): e0128450.
4. De Boer AG., et al. “Drug absorption by sublingual and rectal routes”. British Journal of Anaesthesia 56.1 (1984): 69–82.
5. Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Premedication in children: A comparison of oral midazolam and oral clonidine. PaediatrAnaesth 2007;17:1143‑9.
6. , Mahfouz AK., Al-Bahrani M. Pre anaesthetic medication in children: A comparison of intranasal dexmeditomedine versus oral midazolam. Saudi J. Anaesth, 2011; 5: 387-91.
7. Meenakshi AL, Sundaram, V Mahesh Mathian. Comparative evaluation of intranasal dexmeditomedine and intransal midazolam for premedication in children: a double blind RCT.JIDA,2011; 5:777-81.
8. Yuen VM, Hui TW, Irwin MG, Yeun MK. A comparison of intransal dexmedetomidine and oral midazolam for premedication in pediatric Anaesthesia: a double blinded randomized controlled trial.  Anaesthesia-Analgesia, 2008;106(1): 1715-21.
9. Malineni N, Patil MC. “Comparative evaluation of intranasal dexmedetomidine and intranasal midazolam for premedication in children undergoing anesthesia”: A 1-year double-blind randomized controlled trial. Indian J Health Sci Biomed Res 2017;10:155-9.
10. Davis Peter J, Tome Julie A, McGowan Francis X Jr, Cohen Ira-Todd, Latta Karen RN, Felder Herman. Preanesthetic medication with intranasal Midazolam for brief pediatric surgical procedures: effect on recovery and hospital discharge times. Anesthesiology, 1995 Jan; 82): 2- 5.
11. Naill CT Wilton, John Leigh, David R Rosen, Uma A Pandit. Preanesthetic sedation of preschool children using intranasal Midazolam. Anesthesiology, 1998; 69: 972-975.
12. Pradipta Bhakta, Ghosh BR, Manjushree Roy, Gauri Mukherjee. Evaluation of intranasal Midazolam for preanaesthetic sedation in pediatric patients. Indian journal of Anesthesia, 2007; 51(2): 111- 116.
13. Pasin L, Febres D, Testa V, Frati E, Borghi G, Landoni G, Zangrillo A. Dexmedetomidinevs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials. 2015 May;25(5):468-76.
14. Sobhan Aich, Dr. Charuta Gadkari. A Comparison of Intranasal Dexmedetomidine and Intranasal Midazolam for Premedication in Children Undergoing Elective Surgeries. IJSR,2015:1730-35.
15. Gupta A, Dalvi NP, Tendolkar BA. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: A prospective randomized double blind trial. J Anaesthesiol Clin Pharmacol 2017;33:236-40.

Vandana Gupta

Resident, Department of Anaesthesia, Sardar Patel Medical College & AGH, Bikaner, Rajasthan, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.