Sajid Binu, Mohamed Taznim, Jumaila M
Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India.
J Anaesthesiol Clin Pharmacol. 2019 Jan-Mar;35(1):36-40. doi: 10.4103/joacp.JOACP_20_18.
Midazolam has been the most popular oral premedicant in children despite its side effects. Dexmedetomidine with its favorable clinical profile is a suitable alternative, but with limited research. The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam as oral premedicants in children.
Eighty children of the American Society of Anesthesiologist physical status I scheduled for elective herniotomy were included in this prospective randomized double-blind study. Patients were randomly assigned to receive either dexmedetomidine 4 μg/kg (Group A, = 40) or midazolam 0.5 mg/kg (Group B, = 40) orally 40 min before induction. Pre-operative sedation, response to parental separation and venepuncture, emergence agitation, recovery nurse satisfaction, and side effects were compared between the two groups. Quantitative data were compared using unpaired Student's -test and categorical variables with Chi-square test.
Pre-operative sedation and response to parental separation and venepuncture were similar between the two groups. Group A had a significantly lower incidence and severity of emergence agitation ( = 0.000). Recovery nurse satisfaction was significantly higher in Group A ( = 0.002). However, incidence of hypotension and bradycardia was found to be more in Group A ( = 0.04).
Premedication with oral dexmedetomidine is as effective as oral midazolam in providing sedation and anxiolysis in children. Dexmedetomidine in addition reduces the incidence and severity of emergence agitation.
尽管咪达唑仑有副作用，但它一直是儿童中最常用的口服术前用药。右美托咪定具有良好的临床特性，是一种合适的替代药物，但相关研究有限。本研究的目的是比较右美托咪定和咪达唑仑作为儿童口服术前用药的有效性。
本前瞻性随机双盲研究纳入了80例美国麻醉医师协会身体状况I级、计划进行择期疝修补术的儿童。患者在诱导前40分钟被随机分配口服右美托咪定4μg/kg（A组，n = 40）或咪达唑仑0.5mg/kg（B组，n = 40）。比较两组之间的术前镇静、对与父母分离和静脉穿刺的反应、苏醒期躁动、恢复室护士满意度及副作用。定量数据采用非配对t检验进行比较，分类变量采用卡方检验。
两组之间术前镇静以及对与父母分离和静脉穿刺的反应相似。A组苏醒期躁动的发生率和严重程度显著更低（P = 0.000）。A组恢复室护士满意度显著更高（P = 0.002）。然而，发现A组低血压和心动过缓的发生率更高（P = 0.04）。
口服右美托咪定进行术前用药在为儿童提供镇静和抗焦虑方面与口服咪达唑仑同样有效。此外，右美托咪定还可降低苏醒期躁动的发生率和严重程度。
