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Amer Zahoor Syed*, MD; Bashir A. Dar MD, PDCC; Aarif Lone MD; Talib Khan MD; Zulfiqar Ali MD, DM; Tantry Tariq Gani MD


Background and Aims: Midazolam is frequently used a premedication in children. It is often given orally and gives a reliable sedation and helps in child-parent separation. Oral and parenteral dexmedetomidine have also been increasingly used in paediatric population in recent years. In this study we have compared the use of dexmedetomidine and midazolam and determined the efficacy and safety of dexmedetomidine in pediatric patients. Methods: A prospective, randomized double blind study in pediatric patients aged 6-12 years evaluated the preoperative sedative effects, anxiety level and the ease of child-parent separation, the recovery profile and postoperative analgesic properties of preoperative oral dexmedetomidine compared with those of oral midazolam. We also evaluated safety and efficacy of dexmedetomidine as oral premedication in children. The patients were randomly allocated into two groups: Group- 1(GD) children received dexmedetomidine as premedication 3μg/kg diluted in 5ml dextrose 5% orally (n = 50), one hour prior to anesthesia induction and Group-2 (GM) children received midazolam premedication, 0.5 μg/kg diluted in 5ml dextrose 5% orally (n=50), one hour prior to induction of anesthesia. The data was collected for Heart rate (HR), Mean Arterial Pressure (MAP) pulse oximetry (SPO2) and respiratory rate (RR) in pre and post operative period, response to separation, post operative sedation and any adverse event. The data was collected up to 60 minutes postoperatively at various predetermined intervals for each patient. Data was analyzed statistically using the student t- test, chi square test and repeated measurement analysis to detect differences between two groups. P value of <0.05 was considered statistically significant. Results: Mean heart rate in midazolam group was higher which was statistically significant with p value of <0.05. The MAP in intra operative and post operative period in midazolam group was higher than in dexmedetomidine group which was statistically significant (p< 0.001). The RR at 30 min, 45 min and 60 min was lower in midazolam group than dexmedetomidine group (p< 0.001). The Parent - Child Separation Scores at one hour after administering the study drugs was found to be significantly better in dexmedetomidine group. The Postoperative recovery score was lower in dexmedetomidine group (p <0.05). The recovery for patients who received dexmedetomidine was better and the difference was found statistically significant .The Postoperative Pain Scores were 2.844±.051 in midazolam group and 2.060±.051 in dexmedetomidine group and was statistically significant (p <0.05). Conclusion: Oral dexmedetomidine as a premedicant in pediatric patient is a safe alternative to oral midazolam and has lesser effect on respiratory rate than midazolam. Post operative analgesia was better with dexmedetomidine.

Keywords: Dexmedetomidine, Midazolam, Premedication, Children.

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