Intranasal dexmedetomidine versus intranasal midazolam as a premedication in pediatrics undergoing upper GI endoscopy

Background: Upper GI endoscopy is a common procedure performed in pediatric. Reducing peri-operative anxiety is a crucial concept for the pediatric anesthesiologist. Anxiety can give aggressive responses and make difficulty on postoperative pain control. Pre-anesthetic medication should focus on reducing this anxiety and psychological trauma and to assist the induction of anesthesia with rapid recovery. The aim of this work is to compare the effectiveness of intranasal dexmedetomidine and midazolam as a premedication in sedation of preschool children in upper Gastro-intestinal (GI) endoscopy. Patients and Methods: 70 pediatric patients scheduled for upper GI endoscopy, aged 2 to 6 years old of both sex, with physical status ASA I – II. All patients were randomized into two groups: group M (Midazolam): 35 patients received intranasal midazolam (0.2 mg/kg) up to 5 mg -. Group D (dexmedetomidine): 35 patients received intranasal dexmedetomidine (1 microgram/kg), Intranasal 0.5 ml was administrated in each nostril 30 min before induction with monitoring of sedation level and oxygen saturation. Separation from the parent was recorded by Parental Separation Anxiety Scale (PSAS) and Onset of sedation was monitored by Modified RAMSAY Sedation Scale both recorded in preoperative holding area, Post-operative emergence delirium was monitored by Pediatric Anesthesia Emergence Delirium (PAED) and Agitation was recorded by pediatric sedation agitation scale (PSAS) both recorded in Post-anesthesia care unit (PACU). Results: In the present study, the children were early separated from parents in midazolam group when compared to the dexmedetomidine group 5.14 ± 1.77 min vs 17.49 ± 4.05 min respectively with p value < 0.001. Furthermore, children in dexmedetomidine group achieved significant lower parent separation anxiety, agitation, and delirium scores postoperatively in comparison to midazolam group with p value < 0.001. Conclusion: In children undergoing upper GI endoscopy, premedication with dexmedetomidine at a dose of 1 pg/kg resulted in reasonable sedation, better parent separation, and lower postoperative agitation and delirium compared to intranasal midazolam at 0.2 mg/kg. However, dexmedetomidine had a delayed onset of action.