A Comparison of Intranasal Dexmeditomidine versus Intranasal Midazolam as a pre Anesthetic Medication in Children Undergoing Adenotonsillectomy

Abstract

Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post- operative anxiety is an important concern for the pediatric anesthesiologist. Anxiety can produce aggressive reactions, increase distress, and may make the control of postoperative pain difficult. Pre-anesthetic medication in children should aim at relieving this anxiety and psychological trauma and also to facilitate the induction of anesthesia without prolonging the recovery The benzodiazepine (midazolam) a GABA receptor stimulator is the most commonly used sedative drug for premedication in children. Administered intranasal, midazolam is an effective option for conscious sedation Midazolam has a number of beneficial effects when used as premedication in children: sedation, fast onset, and short duration of action. Despite having a number of beneficial effects, it is far from an ideal pre-medicate having side effects such as restlessness, paradoxical hyperactive reaction, cognitive impairment, amnesia, and respiratory depression. Dexmedetomidine is a newer alpha 2-agonist with a more selective action on the alpha adrenoceptor with both sedative and analgesic properties and is devoid of respiratory depressant effect. Its bioavailability is (72.6–92.1%) when administered via the nasal mucosa. These properties render it potentially useful for anesthesia premedication.