Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery

Mark D. Talon, Lee C. Woodson, Edward R. Sherwood, Asle Aarsland, Laksmi McRae, Tobin Benham

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)599-605
Number of pages7
JournalJournal of Burn Care and Research
Volume30
Issue number4
DOIs
StatePublished - Jul 2009

Fingerprint

Reconstructive Surgical Procedures
Dexmedetomidine
Premedication
Midazolam
Adrenergic alpha-2 Receptor Agonists
General Anesthesia
Anesthesia
Postoperative Pain
Sleep
Nurse Anesthetists
Pediatrics
Intranasal Administration
Research Ethics Committees
Isoflurane
Methadone
Nitrous Oxide
Pharmaceutical Preparations
Morphine
Reflex
Analgesics

ASJC Scopus subject areas

  • Emergency Medicine
  • Rehabilitation
  • Surgery

Cite this

Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. / Talon, Mark D.; Woodson, Lee C.; Sherwood, Edward R.; Aarsland, Asle; McRae, Laksmi; Benham, Tobin.

In: Journal of Burn Care and Research, Vol. 30, No. 4, 07.2009, p. 599-605.

Research output: Contribution to journalArticle

Talon, Mark D. ; Woodson, Lee C. ; Sherwood, Edward R. ; Aarsland, Asle ; McRae, Laksmi ; Benham, Tobin. / Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. In: Journal of Burn Care and Research. 2009 ; Vol. 30, No. 4. pp. 599-605.
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