Aug 2026· Journal of Nepal Health Research Council· Vol 24 1, pp.
95-101
· 0 citations
Medicine
TL;DR
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.
Abstract
Background
Preoperative sedation in children is necessary as it is a common source of distress, potentially leading to difficult induction. Intranasal dexmedetomidine bypasses hepatic metabolism and has good availability. It is non invasive, easy with minimal respiratory depression. This study aimed to observe safety, efficacy, sedation level and parental separation score following a fixed dose of 1.5 mcg/kg Methods: A cross sectional study design was conducted among 43 children posted for elective surgeries. After informed consent and assent were obtained, intranasal DEX 1.5mcg/kg was administered. Satisfactory sedation was defined as a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of ? 3, and satisfactory parental separation as a score of ? 2 on a 4-point scale. Physiological parameters (HR, RR, SPO2 were monitored for 30 minutes. Statistical analysis involved the use of SAS version 9.4.
Results
Satisfactory sedation ? 3 was achieved in 93.0% of subjects by 30 minutes (95% CI: 80.9%-98.5%). Similarly, satisfactory parent-child separation ? 2 score was achieved in 93.0% of subjects. Mean heart rate progressively decreased from 107.12±14.20 at baseline to 85.47 ± 7.29 beats per minute at 30 minutes, which was well tolerated.
Conclusions
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.
Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery.
Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed.
Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09).
Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.
AVINASH KAREKAL, SRINIVAS KURAHATTI, Rashmi C· Asian Journal of Pharmaceuti...· 0 citations
S-ketamine provides superior analgesia and reduces intraoperative opioid requirements without compromising sedation or anxiolysis, suggesting it may be a preferable option in this population of children undergoing tonsillectomy.
Ivana Fajertag, Vlado Janković, Maja Sujica et al.· Serbian Journal of Anesthesi...· 0 citations
Both intranasal dexmedetomidine and inhaled nitrous oxide offered effective analgosedation for intra-articular injections in children and Nitrous oxide resulted in better patient experience and became their preference for future sedation.
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Both agents are effective for short procedural sedation, whereas propofol ensures faster recovery, and Dexmedetomidine offers superior cardiorespiratory stability, whereas propofol ensures faster recovery.
Vikash Gaurav· International Journal of Pha...· 0 citations
The clinical management of established postoperative delirium (POD) is particularly challenging in patients who exhibit agitated behavior and self-remove intravenous (IV) access. A 70-year-old man with prior cerebral infarction developed POD following urologic surgery under general anesthesia. Two doses of IV diazepam failed to provide sustained relief, and the patient subsequently self-removed his IV catheter. Intranasal (IN) dexmedetomidine was administered in a stepwise titration protocol (total dose: 100 μg). The patient transitioned from agitation to calm and entered sustained sleep within 1 h. The only hemodynamic alteration observed was mild bradycardia (heart rate: 58–65 beats/min), with no clinically significant respiratory depression occurring throughout the observation period. The Confusion Assessment Method (CAM) test result was negative on postoperative day 2, and the patient was discharged uneventfully on postoperative day 4. This case suggests that IN dexmedetomidine may offer a safe, non-invasive rescue option for established POD when IV access is unavailable.
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.