Efficacy Observation Of Dexmedetomidine Nasal Drops And Oral Administration Of Midazolam As A Pediatric Anesthetic Premedication

Objective:To observe the sedative efficacy of dexmedetomidine nasal drops and oral administration of midazolam as a pediatric anesthetic premedication. Methods:160 children(ASA:Ⅰ-Ⅱ) undergoing general anesthesia surgery were selected. 98 cases were boy, 62 cases were girl, and their age was between 1-6 years old. They were given the dexmedetomidine or midazolam 35 minutes before they entered the surgery room, and were randomly divided into five groups according to the administration-the dexmedetomidine group(Group I: the dosage was1μg/kg, GroupⅡ: the dosage was 2μg/kg), the midazolam group(GroupⅢ: the dosage was 0.5mg/kg), the combined use of dexmedetomidine and midazolam group(Group IV: the dosage was 1μgkg of dexmedetomidine in conjunction of 0.5mg/kg midazolam, Group V: the dosage was 2μg/kg of dexmedetomidine in conjunction of 0.5mg/kg midazolam). Children’s breath condition was monitored by pulse oximetry, and any adverse reaction was recorded and managed, i.e. allergy, respiratory depression, etc. Other monitoring includes routine ECG monitor and Bispectral. Assistant respiration was given through bag-mask ventilation, and the anesthesia induction condition was assessed. 8% sevoflrane inhalation was given, the venous access was established, propofol(2mg/kg), cisatracurium besylate(0.1mg/kg), and Fentanyl(3μg/kg) were used for induction of anesthesia. Mechanical ventilation was employed after trachea intubation. Sevoflrane inhalation was given during the surgery. The anesthesia vaporizer was Set according to the circulatory condition of the children. MOAA/S, state of the children without the company of their parents, HR, MAP, SpO2, occurrence of allergy, respiratory depression, and complication, the anesthesia induction condition, and BIS were recorded. Results:1. General information: 5 cases of the 160 cases was dropped out: 3 children strongly refused and couldn’t tolerate nasal drop, and vomiting occurred in two children after oral administration. There was no significant difference among the selected subjects in terms of general information.2. Comparison of parameters of the life signs: the HP and MAP decreased significantly after administration in Group I, II, IV and V; no significant change of SpO2 was observed after administration among the five Groups.(P>0.05).3. Comparison of children assessment and BIS3.1 MOAA/S after the administration: it decreased significantly in the five groups; the OAA/S of Group III(3.49±1.30) was significantly different from the other four groups; the MOAA/S of Group II was lower than the Group I, but there was no statistical significance; the MOAA/S of Group IV and V decreased significantly(P<0.05).3.2 Comparison of the state of the children without the company of their parents: The rating of satisfaction of Group II, IV and V were much higher than Group III; there was no significant difference among Group I, II, IV and V.3.3 Comparison of the anesthesia induction condition: there was no significant difference among the five Groups.3.4 Comparison of BIS: Group III(81±5) was significantly higher than the rest four groups(P<0.05); there was there was no significant difference among Group I, II, IV and V in terms of BIS.3.5 Comparison of adverse reactions: two cases presented vomiting and withdraw from the study(in Group II and Group IV); no allergy and severe heart rate decrease occurred; one case in Group III and IV respectively, and two cases in Group V presented decrease of SpO2(dropped to 95%), the normal state was restored after oxygen was applied. Conclusion:The sedative efficacy of single use of dexmedetomidine nasal drop in a dosage of 1μg/kg or 2μg/kg, or combined with oral administration of midazolam(0.5mg/kg) was superior than the single use of midazolam(0.5mg/kg), dexmedetomidine nasal no dose dependence; The sedative efficacy of use of dexmedetomidine nasal drop in a dosage of 1μg/kg or 2μg/kg combining with oral administration of midazolam(0.5mg/kg) was superior than the single use of dexmedetomidine nasal drop in a dosage of 1μg/kg or 2μg/kg, and did not increase the incidence of postoperative adwerse reactions,It was more worthy of clinical promotion.