A comparison of intranasal dexmeditomidine versus intranasal midazolam as a pre anesthetic medication in children undergoing adenotonsillectomy

Background Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post-operative anxiety is an important concern for the pediatric anesthesiologist. Aim of the Work: to compare dexmedetomidine with midazolam effect on preoperative sedation, the ease of children parent separation, the mask tolerance, intraoperative hemodynamics stability, emergence of anesthesia and postoperative analgesia. Patients and Methods A Prospective, randomized and double blind controlled clinical trial was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include fifty pediatric patients, aged 5 to 10 years old of both genders, with physical status ASA Ι. Results statistically significant increase mean of Dexmedetomidine compared to midazolam according to sedation score after 15min. to after 45min. Conclusion Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam 0.2 mg/kg in children undergoing adenotonsillectomy.

Pediatric Airway Fundamentals

This chapter describes the important anatomic and physiologic differences between the child and adult pertinent to airway management. Equipment specific for pediatric airway management, including laryngoscopes, endotracheal tubes, and supraglottic airways, are described. It is critical that the pediatric anesthesiologist have specialized knowledge of and training for the pediatric airway as well as the correct equipment available for airway management. Many specialized options for airway management have become available in recent years, including Microcuff endotracheal tubes and new types of supraglottic airways. This chapter provides detailed step-by-step guidance on the basics of pediatric airway management. A useful reference feature included are charts on sizing of endotracheal tubes, laryngeal mask airways, the i-gel device, and the air-Q device.