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Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial.
Paediatr Anaesth 2014; 24(2):181-9PA

Abstract

BACKGROUND

This prospective, randomized, double-blind study was designed to evaluate the use of intranasally administered dexmedetomidine vs intranasal midazolam as a premedication in children undergoing complete dental rehabilitation.

METHODS

Seventy-two children of American Society of Anesthesiology classification (ASA) physical status (I & II), aged 3-6 years, were randomly assigned to one of two equal groups. Group M received intranasal midazolam (0.2 mg·kg(-1)), and group D received intranasal dexmedetomidine (1 μg·kg(-1)). The patients' sedation status, mask acceptance, and hemodynamic parameters were recorded by an observer until anesthesia induction. Recovery conditions, postoperative pain, and postoperative agitation were also recorded.

RESULTS

The median onset of sedation was significantly shorter in group M 15 (10-25) min than in group D 25 (20-40) min (P = 0.001). Compared with the children in group M, those in group D were significantly more sedated when they were separated from their parents (77.8% vs 44.4%, respectively) (P = 0.002). Satisfactory compliance with mask application was 58.3% in group M vs 80.6% in group D (P = 0.035). The incidences of postoperative agitation and shivering were significantly lower in Group D compared with group M. Thirteen children (36.1%) in group M, showed signs of nasal irritation with teary eyes, and none of these signs was seen in the children in group D (P = 0.000). There were no incidences of bradycardia, hypotension, in either of the groups during study observation.

CONCLUSION

Intranasal dexmedetomidine (1 μg·kg(-1)) is an effective and safe alternative for premedication in children; it resulted in superior sedation in comparison to 0.2 mg·kg(-1) intranasal midazolam. However, it has relatively prolonged onset of action.

Authors+Show Affiliations

Division of Anesthesiology, Department of Oral maxillofacial Surgery & Anesthesia, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24237879

Citation

Sheta, Saad A., et al. "Intranasal Dexmedetomidine Vs Midazolam for Premedication in Children Undergoing Complete Dental Rehabilitation: a Double-blinded Randomized Controlled Trial." Paediatric Anaesthesia, vol. 24, no. 2, 2014, pp. 181-9.
Sheta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Paediatr Anaesth. 2014;24(2):181-9.
Sheta, S. A., Al-Sarheed, M. A., & Abdelhalim, A. A. (2014). Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Paediatric Anaesthesia, 24(2), pp. 181-9. doi:10.1111/pan.12287.
Sheta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal Dexmedetomidine Vs Midazolam for Premedication in Children Undergoing Complete Dental Rehabilitation: a Double-blinded Randomized Controlled Trial. Paediatr Anaesth. 2014;24(2):181-9. PubMed PMID: 24237879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. AU - Sheta,Saad A, AU - Al-Sarheed,Maha A, AU - Abdelhalim,Ashraf A, Y1 - 2013/11/15/ PY - 2013/09/30/accepted PY - 2013/11/19/entrez PY - 2013/11/19/pubmed PY - 2014/8/29/medline KW - dental rehabilitation KW - dexmedetomidine KW - midazolam KW - pediatric KW - premedication KW - sedation SP - 181 EP - 9 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 24 IS - 2 N2 - BACKGROUND: This prospective, randomized, double-blind study was designed to evaluate the use of intranasally administered dexmedetomidine vs intranasal midazolam as a premedication in children undergoing complete dental rehabilitation. METHODS: Seventy-two children of American Society of Anesthesiology classification (ASA) physical status (I & II), aged 3-6 years, were randomly assigned to one of two equal groups. Group M received intranasal midazolam (0.2 mg·kg(-1)), and group D received intranasal dexmedetomidine (1 μg·kg(-1)). The patients' sedation status, mask acceptance, and hemodynamic parameters were recorded by an observer until anesthesia induction. Recovery conditions, postoperative pain, and postoperative agitation were also recorded. RESULTS: The median onset of sedation was significantly shorter in group M 15 (10-25) min than in group D 25 (20-40) min (P = 0.001). Compared with the children in group M, those in group D were significantly more sedated when they were separated from their parents (77.8% vs 44.4%, respectively) (P = 0.002). Satisfactory compliance with mask application was 58.3% in group M vs 80.6% in group D (P = 0.035). The incidences of postoperative agitation and shivering were significantly lower in Group D compared with group M. Thirteen children (36.1%) in group M, showed signs of nasal irritation with teary eyes, and none of these signs was seen in the children in group D (P = 0.000). There were no incidences of bradycardia, hypotension, in either of the groups during study observation. CONCLUSION: Intranasal dexmedetomidine (1 μg·kg(-1)) is an effective and safe alternative for premedication in children; it resulted in superior sedation in comparison to 0.2 mg·kg(-1) intranasal midazolam. However, it has relatively prolonged onset of action. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/24237879/Intranasal_dexmedetomidine_vs_midazolam_for_premedication_in_children_undergoing_complete_dental_rehabilitation:_a_double_blinded_randomized_controlled_trial_ L2 - https://doi.org/10.1111/pan.12287 DB - PRIME DP - Unbound Medicine ER -