A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

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Comparative study between intranasal dexmedetomidine and intranasal ketamine as a premedication for anxiolysis and sedation before pediatric general anesthesia

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00104-8 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Ahmed Elsayed Ahmed Mohamed Elshafeey ◽

Gehan Fouad Kamel Youssef ◽

Ehab Hamed Abd Elsalam ◽

Mohamed Saleh ◽

Ramy Mahrose

Keyword(s):

General Anesthesia ◽

Pediatric Patients ◽

Sedation Score ◽

University Hospital ◽

Sedation Level ◽

Significant Difference ◽

Sedation Scores ◽

Double Blinded ◽

Group D ◽

Effective Sedation

Abstract Background This study compared dexmedetomidine versus ketamine as regard sedation and anxiolysis produced by giving them through intranasal route to pediatric patients undergoing adenotonsillectomy. This study was double-blinded randomized comparative prospective interventional clinical study done in Ain Shams University Hospital (El Demerdash Hospital) on 76 pediatric patients who underwent adenotonsillectomy, and they were randomly allocated equally into two main groups; group D received 2 μg/kg intranasal dexmedetomidine and group K received 5 μg/Kg intranasal ketamine 30 min before the operation, and the aim of this study was to compare the efficacy of intranasal dexmedetomidine versus intranasal ketamine for anxiolysis and sedation to alleviate stress, agitation, and anxiety in children before general anesthesia and for promoting good level of sedation for them. Results Results of this study as regards sedation level that was assessed by modified Ramsay sedation score showed that there was statistically significant difference between both groups at 10, 20, and 30 min from intranasal application of the drug (P value < 0.05), the median (IQR) of sedation score at 10, 20, and 30 min preoperative in group D was (2 (2 – 2)), (3 (3 – 4)), (4 (4 – 5)) compared to (2 (2 – 3)), (3 (2 – 3)), (4 (3 – 4)) in group K respectively which revealed that there was better and effective sedation in group D more than in group K, this difference was statistically significant but clinically insignificant as both drugs produced an acceptable level of sedation and decreased the level of anxiety in children. Conclusion Both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and time of onset of sedation, and also there was little decrease in heart rate and mean arterial pressure which is favorable during such surgeries; also, there was accepted level of cannulation and parental separation scores, and the parents were highly satisfied with the procedure and were grateful for us due to alleviating stress and anxiety from them and from their children.

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Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

BioMed Research International ◽

10.1155/2020/5142913 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Li Wang ◽

Lili Huang ◽

Tiejun Zhang ◽

Wei Peng

Keyword(s):

Separation Anxiety ◽

Pediatric Anesthesia ◽

Pediatric Dentistry ◽

Parental Separation ◽

Hemodynamic Parameters ◽

Emergence Delirium ◽

Oral Midazolam ◽

Significant Difference ◽

Acceptance Scale ◽

Parental Separation Anxiety

The aim of this study was to compare the effects of preoperative intranasal dexmedetomidine and oral midazolam on preoperative sedation and postoperative agitation in pediatric dentistry. A total of 60 children (ASA grade I, aged 3–6 years) scheduled for elective pediatric dental treatment were randomly divided into the dexmedetomidine (DEX) and midazolam (MID) groups. Ramsay sedation score, parental separation anxiety scale, mask acceptance scale, pediatric anesthesia emergence delirium scale, and hemodynamic parameters were recorded. The Ramsay sedation scale and hemodynamic parameters of the children were observed and recorded immediately before administration and 10, 20, and 30 min after administration. A satisfactory mask acceptance scale rate was 93.33% in both MID and DEX groups, and there was no significant difference between the two groups (p>0.05). The proportions of children that “successfully separated from their parents” were 93.33% (MID) and 96.67% (DEX). No significant difference was found between the two groups (p>0.05). The incidence of agitation was 20% in the MID group and 0% in the DEX group, and the difference was statistically significant (p<0.05). Intranasal dexmedetomidine and oral midazolam provided satisfactory sedation. No significant difference between the two groups was found in terms of parental separation anxiety and mask acceptance (p>0.05). The incidence of postoperative pediatrics emergence delirium was significantly lower in the DEX group (p<0.05).

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The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

10.21203/rs.3.rs-125287/v1 ◽

2020 ◽

Author(s):

Xiaoxia Gu ◽

Jingjing Wang ◽

Huihua Liao ◽

Jian Mo ◽

Weiming Huang ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Adverse Reactions ◽

Visceral Pain ◽

Sedation Score ◽

Efficacy And Safety ◽

Significant Difference ◽

Group A ◽

Group B ◽

Group D ◽

Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

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Music listening for anxiety relief in children in the preoperative period: a randomized clinical trial

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1121.2841 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 5

Author(s):

Mariana André Honorato Franzoi ◽

Cristina Bretas Goulart ◽

Elizabete Oliveira Lara ◽

Gisele Martins

Keyword(s):

Clinical Trial ◽

Elective Surgery ◽

Nursing Intervention ◽

Preoperative Anxiety ◽

Control Group ◽

Music Listening ◽

Preoperative Period ◽

Significant Difference ◽

Anxiety Levels ◽

Experimental Group

ABSTRACT Objective: to investigate the effects of music listening, for 15 minutes, on the preoperative anxiety levels in children undergoing elective surgery in comparison with conventional pediatric surgical care. Method: randomized controlled clinical trial pilot study with 52 children in the preoperative period, aged 3 to 12 years, undergoing elective surgery and randomly allocated in the experimental group (n = 26) and control group (n = 26). Anxiety was assessed in both groups by the application of the modified Yale Preoperative Anxiety Scale and measurement of the physiological variables, upon arrival and 15 minutes after the first measurement. Results: there was a statistically significant difference in preoperative anxiety between the two groups only in relation to the physiological variable, since the respiratory rate of preschool children in the experimental group reduced in the second measurement compared to the control group (p = 0.0453). The experimental group showed a statistically significant reduction in anxiety levels after 15 minutes of music listening (p = 0.0441), specifically with regard to the behavioral domains of activity, vocalization, emotional expression and apparent awakening state. Conclusion: music listening emerges as a potential nursing intervention for relief of preoperative anxiety in children undergoing surgical procedures. RBR-7mcr59.

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Comparison of morphine and fentanyl in attenuation of Intra operative stress response under general anesthesia: A randomized double blinded study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i4.9796 ◽

2014 ◽

Vol 5 (4) ◽

pp. 65-68

Author(s):

R Krishna Prabu ◽

P Rani ◽

NP Madhu

Keyword(s):

Body Weight ◽

Stress Response ◽

General Anesthesia ◽

Elective Surgery ◽

Serum Cortisol ◽

Blood Samples ◽

Significant Difference ◽

Blinded Study ◽

Cortisol Levels ◽

Double Blinded

Background: This randomized double blinded study was done to compare the effect of intravenous morphine and fentanyl in attenuation of stress response during surgeries under general anesthesia in adults. The attenuation of stress response was analyzed with changes in serum cortisol and glucose levels one hour after induction of anesthesia. Methods: Fifty consented healthy volunteers in age group 20-50, under ASA I and ASA II posted for elective surgery were included in the study. Two groups of 25 each, group M who received 0.2 mg/kg body weight of morphine and group F who received 2 microgram/kg body weight of fentanyl before anaesthetic induction were compared. The members of two groups were randomly allocated and double blinded using sealed envelope technique. Blood samples were collected for baseline glucose and cortisol in all the subjects. One hour after the administration of study drugs, which was given at the time of induction blood samples were collected for analysis of glucose and cortisol. The changes in blood glucose and serum cortisol levels were compared at the end of the study using independent samples ‘t’ test. Results: There was no significant difference in blood sugar levels in both groups at the end of 1 hour. But there was significant increase in serum cortisol levels in group F compared to group M. Conclusion: This study concludes that morphine is better than fentanyl in attenuation of Intraoperative stress by effectively controlling serum cortisol levels. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9796 Asian Journal of Medical Sciences 2014 Vol.5(4); 65-68

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Incidence of Emergence Agitation in Pediatric Patient after General Anesthesia

Folia Medica Indonesiana ◽

10.20473/fmi.v55i1.24340 ◽

2021 ◽

Vol 55 (1) ◽

pp. 25

Author(s):

Lucky Andriyanto ◽

Arie Utariani ◽

Elizeus Hanindito ◽

Kohar Hari Santoso Hari Santoso ◽

Hamzah Hamzah ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Pediatric Patient ◽

Pediatric Anesthesia ◽

Routine Care ◽

Preoperative Anxiety ◽

Emergence Agitation ◽

Spss Software ◽

Associated Risk Factors ◽

Dissociated State

Post anesthesia agitation is common problem in pediatric post anesthesia care unit. The incidences range from 10 to 80%. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, and uncooperative typically thrashing, crying, moaning or incoherent. This study was done to determine the incidence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This descriptive and analytic study was performed on 105 pediatric patient aged 1-12 years that underwent general anesthesia for various elective diagnostic and surgeries at Dr. Soetomo Hospital between January and February 2016. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium (PAED) scale. The factors that linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software with logistic regression. p - values less than 0.05 were considered as significant. Forty two (40%) children had Emergence Agitation. Preoperative anxiety (p = 0.006) and Pain (p=0.035) were associated with higher rates of post anesthetic emergence agitation. This study identified preoperative anxiety and pain as risk factors, which are associated with emergence agitation in children. To minimize the incidence of post anesthetic emergence agitation, these risk factors should be considered in the routine care by anesthetist.

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Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

Frontiers in Pharmacology ◽

10.3389/fphar.2021.648699 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yu-Hang Cai ◽

Cheng-Yu Wang ◽

Yang Li ◽

Jia Chen ◽

Jun Li ◽

...

Keyword(s):

Primary Outcome ◽

Separation Anxiety ◽

Anesthesia Induction ◽

Inhalation Induction ◽

Beneficial Effects ◽

Oral Midazolam ◽

Sedative Effects ◽

Drug Regimens ◽

Group D

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction.Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time.Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001).Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

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Oxycodone 5 Miligram is More Effective Than Ketorolac 30 Miligram in Suppressing Cortisol Levels During General Anesthesia

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v2i1.145 ◽

2021 ◽

Vol 2 (1) ◽

pp. 148-158

Author(s):

Kelvin ◽

Rizal Zainal ◽

Irwanto FH ◽

Erial Bahar

Keyword(s):

General Anesthesia ◽

Sample Size ◽

Intravenous Administration ◽

Elective Surgery ◽

Controlled Trial ◽

Post Intervention ◽

Chi Square ◽

Double Blind ◽

Significant Difference ◽

Cortisol Levels

Background: Preemptive analgesia is a developing clinical concept, which involves administering analgesics before pain stimulation occurs, to prevent the sensitization of the nervous system to further stimuli that can cause pain. Ketorolac has strong analgesic properties oxycodone is a semisynthetic opioid that is synthesized from the alkaloid thebaine opiate. Pain could induce stress hormone such as cortisol. Study to compare ketorolac and oxycodone with cortisol has not been investigated. This study aimed to assess intravenous administration of ketorolac 30 mg compared with intravenous 5 mg oxycodone for pain as measured by cortisol levels post-intervention in surgery performed under general anesthesia. Method: A study randomized controlled trial in double-blind form for patients at dr. Mohammad Hoesin Palembang, who will undergo elective surgery with general anesthesia at the Central Surgical Installation building, with the period September-October 2020. There are 24 study samples, to anticipate dropouts, an added sample size is 10%, so the sample size is 26 for each treatment group. The selection of subjects according to the purpose of the study was carried out by simple random. Data analysis using SPSS ver 22.0 software. Data were analyzed using Independent T-Test, Mann Whitney, and Chi-Square Test. Result: The results showed, there was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and intravenous oxycodone 5 mg on pain as measured by cortisol levels in patients undergoing general anesthesia at dr. Mohammad Hoesin Palembang (p = 0.013). The value of cortisol levels in pre- operative patients who will be given general anesthesia at dr. There was no statistically significant difference between Mohammad Hoesin in the two groups (p = 0.107). The value of cortisol levels in preoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 9.90 ± 4.2. The value of cortisol levels in postoperative patients who were given ketorolac 30 mg intravenously at dr. Mohammad Hoesin was 17.75 ± 6.08. The value of preoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin was 12.03 ± 5.10. The value of postoperative cortisol levels for patients who were given oxycodone 5 mg intravenously at dr. Mohammad Hoesin is 14.50 ± 4.75. Conclusion: There was a significant difference in the effectiveness of intravenous administration of ketorolac 30 mg and oxycodone 5 mg intravenously on BSS levels (p = 0.005) and VAS scores (p = 0.001) who underwent general anesthesia at dr. Mohammad Hoesin Palembang.

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A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20163110 ◽

2016 ◽

Vol 2 (9) ◽

pp. 227

Author(s):

Smita R. Engineer ◽

Digant B. Jansari ◽

Saumya Saxena ◽

Rahul D. Patel

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Elective Surgery ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Hemodynamic Parameters ◽

Randomized Clinical Study ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference

Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO2 and SPO2, perioperative hemodynamic parameters and intra operative and postoperative complication.Methods: This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In “sniffing air” position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO2 >95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications.Results: No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO2 and ETCO2. Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel.Conclusions: I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO2 and ETCO2 were maintained in both the groups.

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The Effect of Gamification through a Virtual Reality on Preoperative Anxiety in Pediatric Patients Undergoing General Anesthesia: A Prospective, Randomized, and Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm7090284 ◽

2018 ◽

Vol 7 (9) ◽

pp. 284 ◽

Cited By ~ 20

Author(s):

Jung-Hee Ryu ◽

Jin-Woo Park ◽

Francis Nahm ◽

Young-Tae Jeon ◽

Ah-Young Oh ◽

...

Keyword(s):

Virtual Reality ◽

General Anesthesia ◽

Rating Scale ◽

Elective Surgery ◽

Controlled Trial ◽

Final Analysis ◽

Preoperative Anxiety ◽

Control Group ◽

Behavior Rating Scale ◽

Anxiety Induction

The use of gamification in healthcare has been gaining popularity. This prospective, randomized, clinical trial was designed to evaluate whether gamification of the preoperative process—via virtual reality (VR) gaming that provides a vivid, immersive and realistic experience—could reduce preoperative anxiety in children. Seventy children scheduled for elective surgery under general anesthesia were randomly divided into either the control or gamification group. Children in the control group received conventional education regarding the preoperative process, whereas those in the gamification group played a 5 min VR game experiencing the preoperative experience. Preoperative anxiety, induction compliance checklist (ICC), and procedural behavior rating scale (PBRS) were measured. Sixty-nine children were included in the final analysis (control group = 35, gamification = 34). Preoperative anxiety (28.3 [23.3–36.7] vs. 46.7 [31.7–51.7]; p < 0.001) and intraoperative compliance measured using ICC (p = 0.038) were lower in the gamification group than in the control group. However, PBRS (p = 0.092) and parent/guardian satisfaction (p = 0.268) were comparable between the two groups. VR experience of the preoperative process could reduce preoperative anxiety and improve compliance during anesthetic induction in children undergoing elective surgery and general anesthesia.

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