Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Umeå, Sweden.
Paediatr Anaesth. 2021 Nov;31(11):1225-1233. doi: 10.1111/pan.14279. Epub 2021 Aug 26.
Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.
In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.
Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.
In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
儿科患者的焦虑可能会对围手术期麻醉管理造成挑战，并导致术后结果恶化。有多种具有不同药理学特征的镇静药物可用于减轻焦虑，但对于学龄前儿童，其效果或最佳选择尚未达成共识。在本研究中，我们旨在比较三种不同的术前用药对 2-6 岁择期手术的学龄前儿童麻醉诱导前焦虑的影响。次要结局包括外周导管（PVC）插入时的痛苦、麻醉诱导时的配合度以及镇静水平。
这是一项双盲随机临床试验，共纳入 90 名 2-6 岁、拟行耳鼻喉手术的患者。将患者随机分为三组：口服 0.5mg/kg 咪达唑仑、口服 4μg/kg 可乐定或鼻腔内给予 2μg/kg 右美托咪定。采用改良耶鲁术前焦虑量表、行为痛苦量表、预吸氧时面罩配合度检查表和 Ramsay 镇静评分分别测量焦虑、PVC 插入时的痛苦、预吸氧时面罩配合度和镇静水平。
因拒绝服用术前药物而剔除的 6 名儿童被排除在外，最终纳入 84 名患者。在基线时，所有组的术前焦虑和痛苦程度相似。在麻醉准备期间，接受可乐定和右美托咪定的儿童焦虑程度增加，但咪达唑仑组的焦虑程度无变化。各组间 PVC 插入时的痛苦或诱导时的配合度无差异。与咪达唑仑组相比，可乐定和右美托咪定组的儿童镇静水平更高。
与可乐定和右美托咪定相比，咪达唑仑在学龄前儿童中具有更有效的抗焦虑作用和更少的镇静作用。
