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Intranasal Dexmedetomidine Premedication is Comparable With Midazolam in Burn Children Undergoing Reconstructive Surgery

Talon, Mark D. MSN, CRNA*; Woodson, Lee C. MD, PhD*; Sherwood, Edward R. MD, PhD†; Aarsland, Asle MD, PhD†; McRae, Laksmi BA, RN†; Benham, Tobin BSN, RN, CPN‡

doi: 10.1097/BCR.0b013e3181abff90
Original Articles

Preoperative anxiety and emergence delirium in children continue to be common even with midazolam premedication. Midazolam is unpleasant tasting even with a flavored vehicle and as a result, patient acceptance is sometimes poor. As an alternative, we evaluated dexmedetomidine administered intranasally. Dexmedetomidine an alpha-2 adrenergic agonist is tasteless, odorless, and painless when administered by this route. Alpha-2 adrenergic agonists produce sedation, facilitate parental separation, and improve conditions for induction of general anesthesia, while preserving airway reflexes. Institutional review board approval was obtained to study 100 pediatric patients randomized to intranasal dexmedetomidine (2 μg/kg) or oral midazolam (0.5 mg/kg) administered 30 to 45 minutes before the surgery. Subjects received general anesthesia with oxygen, nitrous oxide, isoflurane, and analgesics (0.05–0.1 mg/kg morphine or 0.1 mg/kg methadone). Nurses and anesthetists were blinded to the drug administered and evaluated patients for preoperative sedation, conditions for induction of general anesthesia, emergence from anesthesia, and postoperative pain. Responses of 100 patients (50 dexmedetomidine and 50 midazolam) were analyzed. Dexmedetomidine (P = .003) was more effective than midazolam at inducing sleep preoperatively. Dexmedetomidine and midazolam were comparable for conditions at induction (P > 0.05), emergence from anesthesia (P > 0.05), or postoperative pain (P > 0.05). Both drugs were equieffective in these regards. In pediatric patients, dexmedetomidine 2 μg/kg administered intranasally and midazolam 0.5 mg/kg administered orally produced similar conditions during induction and emergence of anesthesia. Intranasal administration of dexmedetomidine is more effective at inducing sleep and in some circumstances offers a useful alternative to oral midazolam in children.

From the *Department of Anesthesia, Shriners Hospital for Children, University of Texas Medical Branch-Galveston; †Department of Anesthesiology, University of Texas Medical Branch-Galveston, Galveston, Texas; and ‡Department of Nursing, Children's Hospital Denver, Aurora, Colorado.

The funding for this project was made available through the Departments of Anesthesiology at the University of Texas Medical Branch-Galveston and Shriners Hospital for Children.

Address correspondence to Mark Talon, MSN,CRNA, Department of Anesthesiology, University of Texas Medical Branch-Galveston, Route 0591, 301 University Boulevard, Galveston, Texas 77550.

© 2009 The American Burn Association