Intranasal Dexmedetomidine (Precedex) versus Intranasal Midazolam (Dormicum) as a Premedication in Pediatrics Undergoing Upper GI Endoscopy

Abstract Background Upper GI endoscopy is one of the most common surgical procedures performed in pediatric patients. Relieving pre- and post- operative anxiety is an important concern for the pediatric anesthesiologist. Anxiety can produce aggressive reactions, increase distress, and may make the control of postoperative pain difficult. Pre-anesthetic medication in children should aim at relieving this anxiety and psychological trauma and also to facilitate the induction of anesthesia without prolonging the recovery. Aim of the Work The aim of this work is to compare the effectiveness of intranasal dexmedetomidine and midazolam as a premedication in sedation of preschool children in GI endoscopy. Patients and Methods A prospective, randomized and double blind 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 70 pediatric patients, aged 2 to 6 years old of both genders, with physical status ASA I – II. Results In the present study, the children were satisfactorily separated from parents in dexmedetomidine group when compared to the midazolam group; p value <0.001 as also documented by Ayushi that Parental separation was successful in 73.3% of patients in Group SD compared with 46.7% of patients in Group SM (P = 0.035). Furthermore, children in dexmedetomidine group achieved significant lower agitation and delirium postoperative after drug in comparison to midazolam group; regarding delirium: p value <0.001, and regarding agitation: p value <0.001. Conclusion Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower agitation and delirium in the postoperative period as compared to intranasal midazolam 0.2 mg/kg in children undergoing upper GI endoscopy although dexmedetomidine had a delayed onset of action when compared to that of midazolam.