ORAL DEXMEDETOMIDINE VERSUS ORAL MIDAZOLAM AS PREMEDICATION IN CHILDREN

Background: Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but new drugs such as the α2-agonists have emerged as alternatives for premedication in pediatric anesthesia. Objective: The aim of this study was to evaluate the effects of oral dexmedetomidine on the preanesthetic sedation and postoperative recovery profile in children, in comparison to oral midazolam. Methods: We performed a prospective, randomized, controlled study on 60 children, aged 3-10 years, undergoing strabismus surgery. Patients were randomly assigned to receive either oral midazolam 0.5 mg/kg (group M, n = 30) or oral dexmedetomidine 3 μg/kg (group D, n = 30) prior to a standardized sevoflurane anesthetic. Pre- and postoperative sedation, immediate postoperative pain, incidence of postoperative agitation, shivering and vomiting, as well as hemodynamic parameters were compared for the two groups. Results: There was no significant difference in the pre- and postoperative levels of sedation between the two groups, but the onset of sedation was significantly faster in group M (28.4 ± 13.7 min vs. 39.5 ± 14.3 min, P 0.05). Group D showed significantly lower pain scores in the immediate postoperative period, with fewer patients requiring rescue analgesics than in group M (10 vs. 17, P 0.05). The incidence of postoperative agitation was significantly less in the dexmedetomidine group (23% vs. 47%, P 0.05). Postoperative shivering and vomiting occurred less in group D. Mean arterial pressure (MAP) and heart rate (HR) were significantly lower in group D during the intra- and postoperative periods. Conclusion: In this study, premedication with oral dexmedetomidine appeared to be superior to oral midazolam. Despite a slower onset of action, oral dexmedetomidine produced higher levels of postoperative analgesia, less incidence of postoperative agitation, shivering and vomiting. It was also associated with more hemodynamic stability.