Shereef K Muhammed, Chaitali Biswas, Swapnadeep Sengupta, Gauri Mukherjee
Department of Anaesthesiology, Calcutta National Medical College, Kolkata, West Bengal, India.
Indian J Anaesth. 2022 Jun;66(Suppl 4):S200-S206. doi: 10.4103/ija.ija_931_21. Epub 2022 Jun 6.
Preschool age children are psycho-biologically vulnerable to all surgical procedures. In this study, we investigated the effect of nebulised dexmedetomidine, midazolam and ketamine as sedative premedication for alleviating parental separation anxiety, facilitating face mask acceptance and reducing emergence agitation in paediatric patients undergoing general anaesthesia.
A prospective, randomised, double-blind study was done involving 96 children of age 3-7 years, randomly allocated into three equal groups and pre-medicated with either nebulised dexmedetomidine 2 mg/kg (GroupD), midazolam 0.2 mg/kg (GroupM) or ketamine 2 mg/kg (Group K). The scores of sedation scale, parental separation anxiety scale, mask acceptance scale and emergence agitation scale were recorded along with haemodynamic parameters. Two-way repeated measures analysis of variance (ANOVA), post hoc test and Kruskal-Wallis test were used for statistical analysis.
A statistically significant difference in sedation score was seen between the different study groups, χ(2) = 8.561, P = 0.014 with mean rank sedation score of 56.50 for Group D, 38.92 for Group M and 43.84 for Group K. Parental separation anxiety scale score and Mask acceptance scale score also showed statistically significant difference between the different study groups, χ(2) = 9.369, P = 0.009 and χ(2) = 11.97, P = 0.003, respectively.
Nebulisation with dexmedetomidine produced easy parental separation, more satisfactory sedation and face mask acceptance with less postoperative agitation than nebulisation with midazolam or ketamine.
学龄前儿童在心理生物学上对所有外科手术都较为脆弱。在本研究中，我们调查了雾化右美托咪定、咪达唑仑和氯胺酮作为镇静术前用药，对缓解接受全身麻醉的儿科患者的父母分离焦虑、促进面罩接受以及减少苏醒期躁动的效果。
进行了一项前瞻性、随机、双盲研究，纳入96名3 - 7岁的儿童，随机分为三组，分别给予雾化右美托咪定2mg/kg（D组）、咪达唑仑0.2mg/kg（M组）或氯胺酮2mg/kg（K组）进行术前用药。记录镇静量表、父母分离焦虑量表、面罩接受量表和苏醒期躁动量表的评分以及血流动力学参数。采用双向重复测量方差分析、事后检验和Kruskal - Wallis检验进行统计分析。
不同研究组之间的镇静评分存在统计学显著差异，χ(2)=8.561，P = 0.014，D组的平均秩次镇静评分为56.50，M组为38.92，K组为43.84。父母分离焦虑量表评分和面罩接受量表评分在不同研究组之间也显示出统计学显著差异，分别为χ(2)=9.369，P = 0.009和χ(2)=11.97，P = 0.003。
与雾化咪达唑仑或氯胺酮相比，雾化右美托咪定能使父母更容易分离，镇静效果更令人满意，面罩接受度更高，术后躁动更少。
