The Effect Of Low-dose Dexmedetomidine Plus Midazolam On The Preoperative Sedation And The Recovery Quality In Preschool Children

ObjectiveThis study intends to explore the effect of low-dose dexmedetomidine combined with midazolam before surgery on the sedation and recovery in preschool children,with a view to choose the better drug regimen to improve the quality of pediatric anesthesiaMethodsNinety children who met the inclusion criteria were randomized to three groups.Group M was premedicated with midazolam 0.1 mg/kg,group DM1 was premedicated with dexmedetomidine 0.3μg/kg plus midazolam 0.1 mg/kg,group DM2 was premedicated with dexmedetomidine 0.5μg/kg plus midazolam 0.1 mg/kg.After the puncture site was given lidocaine gel for 10 minutes,children were prepared with venous channel in the ward before operation.Fifteen to twenty minutes before surgery,accompanied with parents,the children were given slow intravenous injection of midazolam 0.1 mg/kg or intravenous pumping of dexmedetomidine 0.3μg/kg+midazolam 0.1 mg/kg or dexmedetomidine 0.5μg/kg+midazolam 0.1 mg/kg The final concentration of dexmedetomidine is 5μg/ml or midazolam is 1 mg/ml.The drugs were done within10 to 15 minutes.Five minutes later,the children entered the operating room and were monitored with blood pressure,ECG,Sp O₂,body temperature etc.Anesthesia induction was done with propofol 2 mg/kg,sufentanil 0.3μg/kg,cis-atracurium 0.15 mg/kg,After tracheal intubation,the children were placed in the lateral position and the canal blocking was done with 0.2%ropivacaine 1 ml/kg.Anesthesia was maintained with2～3%sevoflurane,oxygen concentration was 50%.The preoperative sedation score,recovery agitation score and postoperative pain score were recoreded.The anesthesia time,operation time,PACU stay time,and postoperative hospital stay were recorded,too.Results1.There were no statistical difference between the three groups in general conditions,anesthesia time and operation time;2.As for the sedation score after medication,the score in group DM2 is higher than in group DM1（P=0.000）and group M（P=0.004）,there was no statistical difference between group DM1 and group M（P=0.119）3.The extubation time was longer in group DM2 than in group DM1 and group M（P<0.05）.The PCAU stay time in group DM2 and group DM1 was longer than in group M（P<0.01）.There was no statistical difference in postoperative hospital stay between the three groups（P=0.715）.4.As for the recovery agitation score,the score in the group DM2 was lower than in group M（P<0.05）.There was no difference between the three groups on the preoperative sedation score and postoperative pain score at every time point（P>0.05）.ConclusionsThe results of this study indicate that dexmedetomidine 0.5μg/kg plus midazolam 0.1mg/kg intravenous pumping can achieve good preoperative sedation and reduce preoperative separation anxiety in children.What is more,the incidence of recovery agitation can be reduced and the recovery quality was improved.Although it increased the extubation time the recovery time after surgery,it did not prolong postoperative hospital stay time.As a result,it is safe for preoperative sedation and it can improve the quality of pediatric anesthesia.