Comparison of oral dexmedetomidine versus oral midazolam as premedication to prevent emergence agitation after sevoflurane anaesthesia in paediatric patients

M Kavya Prabhu, Sripada G Mehandale, M Kavya Prabhu, Sripada G Mehandale

Abstract

Background and aims: Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA.

Methods: Prospective double-blinded study involving ninety patients aged 1-10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time. Incidence and severity of EA, post-operative pain and requirement of rescue analgesic were assessed at 0, 5, 15, 30 and 60 min postoperatively.

Results: Data were analysed applying Student's t-test and Chi-square test using SPSS software. Mask acceptance was better in Group B (97.8% vs. 73.4%, P < 0.001). Mean arterial pressure was lower in Group B (P < 0.001) though clinically not significant. More rescue analgesic was required in Group A (5.6% vs. 0%). There was no significant difference in adverse effects. Although there was a higher incidence of EA in Group A (Aono's score 3 and 4; 40% vs. 4.4%), none of them required intervention (paediatric anaesthesia emergence delirium score >10; 0 vs. 0).

Conclusion: Premedication with oral dexmedetomidine provides smooth induction and recovery, reduces the EA and provides better analgesia and sedation as compared to oral midazolam.

Keywords: Dexmedetomidine; emergence agitation; midazolam; oral premedication; sevoflurane.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow chart
Figure 2
Figure 2
Comparison of heart rate and mean arterial pressure between the two groups. MAP – Mean arterial pressure; HR – Heart rate
Figure 3
Figure 3
Incidence of emergence agitation as per Aono's four-point scale

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