Intranasal Fentanyl, Midazolam and Dexmedetomidine as Premedication in Pediatric Patients

Veena Chatrath, Rajan Kumar, Upasna Sachdeva, Milind Thakur, Veena Chatrath, Rajan Kumar, Upasna Sachdeva, Milind Thakur

Abstract

Background: Surgery is a very stressful experience for patients. Children are the most susceptible to fear, anxiety, and stress due to their limited cognitive capabilities and dependency. In children, pharmacologic agents are frequently used as premedication to relieve the fear of surgery, to make child-parental separation easy, and to carry out a smooth induction of anesthesia. We conducted this study to compare the efficacy of intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients.

Materials and methods: The present study was conducted prospectively on 75 patients in the age group of 2-6 years of either sex of the American Society of Anesthesiologists physical Class I or II admitted in Guru Nanak Dev Hospital, attached to Government Medical College Amritsar, scheduled to undergo surgery under general anesthesia. The patients were divided into three groups of 25 each. Group F received intranasal fentanyl 1.5 μg/kg body weight, Group M received intranasal midazolam 0.3 mg/kg body weight, and Group D received intranasal dexmedetomidine 1 μg/kg body weight as nasal drops 50 min before surgery.

Results: Children who received intranasal fentanyl and intranasal midazolam had early onset of anxiolysis and sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedicant. Postoperative sedation was better with dexmedetomidine as compared to fentanyl and midazolam.

Conclusion: Onset of action of fentanyl and midazolam is early as compared to that of dexmedetomidine. However, fentanyl provided better conditions for induction and emergence than midazolam. With dexmedetomidine onset of action was delayed and duration of action was prolonged which helped child to remain calm and sedated even after the surgery.

Keywords: Dexmedetomidine; fentanyl; intranasal premedication; midazolam.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Onset of anxiolysis
Figure 2
Figure 2
Onset of sedation
Figure 3
Figure 3
Parental separation score
Figure 4
Figure 4
Quality of induction and mask acceptance
Figure 5
Figure 5
Reaction to intravenous cannulation

References

    1. McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J. Premedication of children with oral midazolam. Can J Anaesth. 1992;39:545–50.
    1. McCann ME, Kain ZN. The management of preoperative anxiety in children: An update. Anesth Analg. 2001;93:98–105.
    1. Lönnqvist PA, Habre W. Midazolam as premedication: Is the emperor naked or just half-dressed? Paediatr Anaesth. 2005;15:263–5.
    1. WCPI Focus on Pain Series: The Three Faces of Fentanyl. [Last retrieved on 2010 Jul 28]. Available from: .
    1. Feld LH, Champeau MW, van Steennis CA, Scott JC. Preanesthetic medication in children: A comparison of oral transmucosal fentanyl citrate versus placebo. Anesthesiology. 1989;71:374–7.
    1. Atcheson R, Lambert DG. Update on opioid receptors. Br J Anaesth. 1994;73:132–4.
    1. Pleuvry BJ. Opioid receptors and their relevance to anaesthesia. Br J Anaesth. 1993;71:119–26.
    1. Hug CC, Jr, Murphy MR. Tissue redistribution of fentanyl and termination of its effects in rats. Anesthesiology. 1981;55:369–75.
    1. Goodchild CS. GABA receptors and benzodiazepines. Br J Anaesth. 1993;71:127–33.
    1. Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003;98:428–36.
    1. 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;24:181–9.
    1. Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: A comparison of intranasal dexmedetomidine versus oral midazolam. Saudi J Anaesth. 2011;5:387–91.
    1. Tawfic TA. Oral preanesthetic medication in children: a comparison of midazolam syrup versus midazolam syrup plus fentanyl lozenge. Alex J Anaesth Intensive Care. 2006;9:13–22.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever