Akin Aynur, Bayram Adnan, Esmaoglu Aliye, Tosun Zeynep, Aksu Recep, Altuntas Resul, Boyaci Adem
Erciyes University Anesthesiology and Intensive Care Unit, Kayseri, Turkey.
Paediatr Anaesth. 2012 Sep;22(9):871-6. doi: 10.1111/j.1460-9592.2012.03802.x. Epub 2012 Jan 23.
Dexmedetomidine, an α(2)-receptor agonist, provides sedation, analgesia, and anxiolytic effects, and these properties make it a potentially useful anesthetic premedication. In this study, we compared the effects of intranasal dexmedetomidine and midazolam on mask induction and preoperative sedation in pediatric patients.
Ninety children classified as ASA physical status I, aged between 2 and 9, who were scheduled to undergo an elective adenotonsillectomy, were enrolled for a prospective, randomized, and double-blind controlled trial. All of the children received intranasal medication approximately 45-60 min before the induction of anesthesia. Group M (n = 45) received 0.2 mg·kg(-1) of intranasal midazolam, and Group D (n = 45) received 1 μg·kg(-1) of intranasal dexmedetomidine. All of the patients were anesthetized with nitrous oxide, oxygen, and sevoflurane, administered via a face mask. The primary end point was satisfactory mask induction, and the secondary end points included satisfactory sedation upon separation from parents, hemodynamic change, postoperative analgesia, and agitation score at emergence.
Satisfactory mask induction was achieved by 82.2% of Group M and 60% of Group D (P = 0.01). There was no evidence of a difference between the groups in either sedation score (P = 0.36) or anxiety score (P = 0.56) upon separation from parents. The number of patients who required postoperative analgesia was higher in the midazolam group (P = 0.045).
Intranasal dexmedetomidine and midazolam are equally effective in decreasing anxiety upon separation from parents; however, midazolam is superior in providing satisfactory conditions during mask induction.
右美托咪定是一种α₂受体激动剂，具有镇静、镇痛和抗焦虑作用，这些特性使其成为一种潜在有用的麻醉前用药。在本研究中，我们比较了鼻内给予右美托咪定和咪达唑仑对小儿患者面罩诱导和术前镇静的效果。
90名年龄在2至9岁、美国麻醉医师协会（ASA）身体状况分级为I级、计划接受择期腺样体扁桃体切除术的儿童被纳入一项前瞻性、随机、双盲对照试验。所有儿童在麻醉诱导前约45 - 60分钟接受鼻内用药。M组（n = 45）接受0.2 mg·kg⁻¹的鼻内咪达唑仑，D组（n = 45）接受1 μg·kg⁻¹的鼻内右美托咪定。所有患者通过面罩给予氧化亚氮、氧气和七氟醚进行麻醉。主要终点是满意的面罩诱导，次要终点包括与父母分离时的满意镇静、血流动力学变化、术后镇痛以及苏醒时的躁动评分。
M组82.2%的患者和D组60%的患者实现了满意的面罩诱导（P = 0.01）。在与父母分离时，两组在镇静评分（P = 0.36）或焦虑评分（P = 0.56）方面均无差异。咪达唑仑组术后需要镇痛的患者数量更多（P = 0.045）。
鼻内给予右美托咪定和咪达唑仑在减轻与父母分离时的焦虑方面同样有效；然而，咪达唑仑在面罩诱导期间提供满意条件方面更具优势。
