Efficacy of Intranasal Dexmedetomidine Versus Oral Midazolam for Preoperative Sedation in Pediatric Patients

Background: Preoperative anxiety is not new to the pediatric patient population and has been linked with lack of cooperation, hard induction and poor perioperative outcomes. To achieve better quality of sedation and lower stress during perioperation, premedication is necessary.

Aim: To compare the effectiveness and safety of intranasal dexmedetomidine and oral midazolam in preoperative sedation in children.

Methods: Prospective randomized controlled study was carried out at Hayat International Hospital with 70 children aged 2 to 10 years (ASA I-II) undergoing elective surgery. The patients were divided into two categories: dexmedetomidine group (2 µg/kg intranasal) and midazolam group (0.5 mg/kg oral). The level of sedation, easy separation of parents, mask acceptance, hemodynamic and adverse effects were measured.

Results: There were no differences in baseline characteristics (p > 0.05). Dexmedetomidine group received the highest scores in sedation (p = 0.001), parental separation (80% vs. 55%; p = 0.02) and mask acceptance (75% vs. 50%; p = 0.03). Dexmedetomidine group had a lower heart rate and mean arterial pressure though it was clinically stable (p < 0.05). The dexmedetomidine group did not experience respiratory depression as compared to the midazolam group. There were no significant differences in adverse effects.

Conclusion: Intranasal dexmedetomidine offers better sedation, enhanced cooperation perioperative, and better safety profile than oral midazolam. It is a safe and effective substitute to pediatric preoperative sedation.