Efficacy and safety of intranasal midazolam, S-ketamine, and dexmedetomidine as premedication for pediatric tonsillectomy: A comparative study (premedication in pediatric tonsillectomy study)

Comparative Evaluation of Oral Ketamine-Dexmedetomidine Versus Oral Ketamine-Midazolam as Premedication in Pediatric Patients Undergoing Elective Surgery Under Anaesthesia

: Background: Preoperative anxiety is a significant challenge in pediatric anaesthesia, necessitating effective premedication strategies. Oral drug combinations offer a non-invasive and child-friendly approach to achieving adequate sedation and anxiolysis. This study evaluates two commonly employed oral premedication regimens-ketamine combined with dexmedetomidine (KD) and ketamine combined with midazolam (KM) — in children aged 2 – 10 years scheduled for elective procedures. Methods: A prospective observational study was conducted at a tertiary care hospital over 14 months (March 2024 – May 2025). Sixty pediatric patients (ASA I – III, aged 2 – 10 years) were allocated into two groups of 30 each. Group KM received oral ketamine 3 mg/kg + midazolam 0.3 mg/kg, and Group KD received oral ketamine 3 mg/kg + dexmedetomidine 3 mcg/kg, each diluted in mango juice and administered 50 minutes before surgery. Sedation was assessed using the Modified Observer's Assessment of Alertness/Sedation (MOAAS) scale, parental separation anxiety score, mask acceptance scale, and hemodynamic parameters. Results: At the 50-minute time point, Group KD showed significantly deeper sedation (MOAAS: 2.1 ± 0.64) compared to Group KM (2.6 ± 0.60; p < 0.05). Parental separation was rated excellent in 90% of KD patients versus 56.7% in KM (p < 0.001). Mask acceptance was superior in KD (83.3% excellent) compared to KM (46.7% excellent; p = 0.006). Hemodynamic parameters remained clinically stable in both groups with no significant intergroup differences. No adverse events were recorded in either group. Conclusion: Both premedication regimens demonstrated acceptable sedative profiles; however, the ketamine-dexmedetomidine combination provided superior sedation depth, smoother parental separation, and better mask acceptance with a comparable safety profile. These findings support ketamine-dexmedetomidine as a preferred oral premedication option in pediatric patients undergoing elective surgery.

Comparative Evaluation of Dexmedetomidine-Midazolam and Fentanyl-Midazolam for Sedation and Analgesia in Lower Extremity Orthopedic Surgery under Spinal Anesthesia: A Randomized Double-Blind Clinical Trial

Background: Spinal anesthesia is a very commonly used procedure in modern-day anesthesia practice. Today most of the lower limb surgeries are performed under spinal anesthesia. Midazolam, dexmedetomidine, and fentanyl are common intravenous adjuvants used during anesthesia to allay anxiety and sedation. The aim of this study was to compare the effects of intravenous dexmedetomidine-midazolam versus fentanyl-midazolam in terms of analgesic characteristics, sedation, and adverse effects. Methods: This is a randomized prospective study that included 35 patients in each group, posted for lower limb orthopedic surgery. Intravenous dexmedetomidine, fentanyl, and midazolam were administered after subarachnoid block. Data for sedation, analgesia, hemodynamic parameters, and adverse effects were recorded. Results: RR for FM group showed significant intra-group variability in RR across perioperative stages (p<0.05), whereas the DM group maintained greater respiratory stability (p=0.243). HR for DM group exhibited significantly lower intraoperative and postoperative HR compared to FM group (p<0.001), with notable within-group changes, unlike the FM group. MAP for both groups remained stable over time (DM: p= 0.283, FM: p= 0.260), although the FM group had slightly higher values in the postoperative recovery phase. Sedation (RSS): DM produced deeper and more sustained sedation intraoperatively and postoperatively (p<0.001), while FM showed quicker sedation decline. Patient satisfaction was significantly higher in the DM group (VAS: 3.0 vs. 4.0, p= 0.001), although surgeon satisfaction did not differ notably. Adverse events were rare and comparable, though hypotension was more frequent in the DM group (22.9% vs. 8.6%). Conclusion: Dexmedetomidine plus midazolam provided superior sedation quality and patient satisfaction, with more stable cardiopulmonary parameters during orthopedic surgery under spinal anesthesia. Despite a slightly higher rate of hypotension, DM appears to offer a more favorable sedative profile compared to fentanyl plus midazolam.

Effect of intranasal midazolam with/without inhalation sedation (N2O/O2) in 3‒6-year-old uncooperative dental patients

To manage the behavior of the children with high levels of dental anxiety, the combination of inhalation sedation with intranasal midazolam can be efficiently used.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AS BOLUS OR LOW-DOSE INFUSION FOR PREVENTION OF EMERGENCE AGITATION AFTER SEVOFLURANE IN PAEDIATRIC ANAESTHESIA

Background:Emergence agitation (EA) is a common and distressing complication following sevoflurane anaesthesia in paediatric patients, characterized by non-purposeful restlessness, crying, and disorientation. Dexmedetomidine, a highly selective α2-agonist, is frequently utilized to prevent EA. However, the optimal administration method, rapid intravenous bolus versus continuous intraoperative infusion, remains debated regarding the balance of efficacy and hemodynamic stability.Aims and Objectives:To systematically compare the clinical effectiveness, postoperative recovery profile, and perioperative hemodynamic stability of a rapid bolus versus a continuous low-dose infusion of dexmedetomidine (0.3 μg/kg) in preventing emergence agitation in children undergoing elective abdominal and genitourinary surgeries under sevoflurane anaesthesia.Materials and Methods:This prospective, randomized, double-blind, comparative study enrolled 80 paediatric patients (ASA physical status I–II, aged 2–12 years) randomly allocated into two equal groups (n=40). Group B received IV dexmedetomidine 0.3 μg/kg as a bolus over 10 minutes; Group I received a continuous infusion at 0.3 μg/kg/hour. Intraoperative Heart Rate and MAP were continuously monitored. Postoperative emergence agitation and pain were assessed using the PAED scale and Observational Pain Scores (OPS) in the PACU.Results:Both techniques provided comparable hemodynamic stability. A transient, statistically significant decrease in MAP (p=0.015) was noted at 10 minutes post dexmedetomidine administration in group B, accompanied by a mild, non significant reduction in heart rate (p=0.184); all values remained within 20% of pre-induction baselines without requiring intervention. Group B demonstrated superior early analgesia (OPSon PACU arrival: 1.8 ± 1.2 vs 4.6 ± 1.8; p<0.001). Extubation times (6.2 ± 1.1 vs 6.5 ± 1.4 min; p=0.284) and emergence times (8.1 ± 1.5 vs 8.4 ± 1.8 min; p=0.418) were highly comparable.Conclusion:A 0.3 μg/kg bolus of dexmedetomidine is hemodynamicallysafe and clinically superior to an equivalent continuous infusion. It provides good early postoperative analgesia and effectively mitigates sevoflurane-induced emergence agitation without extending recovery or extubation times.

Effectiveness of Intranasal Dexmedetomidine for Sedation in Children.

Intranasal DEX at a dose of 1.5 mcg/kg is safe and effective premedication for paediatric patients, which results in successful sedation with tolerated changes in vitals, which was well tolerated.

Impact of Caudal Dexmedetomidine Versus Midazolam on Preventing Emergence Delirium after Sevoflurane Anesthesia in Pediatric Patients: A Prospective Randomized Trial