Cardiorespiratory Response to Sedative Premedication in Preschool Children: A Randomized Controlled Trial Comparing Midazolam, Clonidine, and Dexmedetomidine

• Published in: Journal of perianesthesia nursing 2023-06, Vol.38 (3), p.454-460
• Main Authors: Bromfalk, Åsa, Hultin, Magnus, Walldén, Jakob, Myrberg, Tomi
• Format: Article
• Language: English
• Subjects: cardiorespiratory; Child; Child, Preschool; Clonidine; Dexmedetomidine; Double-Blind Method; Humans; Hypnotics and Sedatives - therapeutic use; Midazolam; pediatric anesthesia; Premedication; Propofol; Remifentanil; sedation
• ISSN: 1089-9472; 1532-8473; 1532-8473
• DOI: 10.1016/j.jopan.2022.08.009

Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia. A single-center randomized controlled trial. This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period. The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P