Full size table Data collection Sex, age, weight, American Society of Anesthesiologists physical status ASAPS , vital signs, sedation onset and recovery times, success of sedation, adverse events, etc. Adverse events and handling Adverse events were classified as severe or minor, and the occurrences of adverse events was recorded. The serious adverse events were: 1 emergency airway intervention the use of tracheal intubation or the placement of airway aids, such as oropharynx or larynx masks ; 2 laryngospasm; 3 reflux aspiration; 4 severe arrhythmia; 5 respiratory and cardiac arrest. All clinical data were analysed using SPSS
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Exclusion criteria include known allergy or hypersensitivity to midazolam or dexmedetomidine, uncorrected congenital heart disease or history of cardiac arrhythmia, children at risk for airway obstruction OSA or cranio facial syndrome and pregnant minors Patients will be randomly assigned to one of two groups M midazolam or D dexmedetomidine using computer-generated numbers in sealed envelopes.
All the patients will be brought to their pre-op room and premedicated at least 30 min before induction of anesthesia.
In M group, patients will be given oral midazolam 0. Atomized nasal medications offer rapid absorption across mucosal membranes to the blood stream avoiding first-pass metabolism.
Parents will be present in the room during premedication. All patients will be continuously monitored in the holding area with pulse oximetry and blood pressure monitor. Emergency medications including atropine and epinephrine will be immediately available in the pre-op holding area. Oral midazolam has been used with very little effect on hemodynamic parameters. Behavior of the children at the time of premedication will be documented easy or difficult.
Any unwanted effects during administration such as spitting or vomiting of oral drug and pain or irritation from nasal administration will be documented. The dental resident blinded to study drug administration will do the pre-operative sedation status and acceptance of mask induction. Sedation status will be assessed using University of Michigan sedation scale UMSS on separation from parents and at induction after moving to the OR table.
Acceptance of mask induction will be documented on a 4-point scale. Standard ASA monitors will be applied before induction of anesthesia. An intravenous line will be inserted and secured. Both nostrils will be prepped nasal drops and tips of tracheal tubes covered with red rubber to minimize bleeding. PACU nurses will evaluate Behavior at awakening using four-point wake up score 9, Patients will also be asked if they remember mask induction yes or no when they are ready for discharge.
Incidence of nausea, vomiting, shivering will be documented in PACU. Time spent in phase 1 recovery room will also be recorded.
Intranasal Dexmedetomidine Premedication in Children
Abstract Background Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Premedication with intranasal IN dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging MRI. Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods We included consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Sedation was maintained with further intravenous thiopental dosing as needed.
Intranasal dexmedetomidine in pediatrics: update of current knowledge.
Dexmedetomidine has a much shorter half life than clonidine hours vs. This pharmacokinetic profile can facilitate brief periods of deep sedation often needed for imaging procedures in pediatric sedation. Use in MRI Evidence supports the use of dexmedetomidine for sedation in mechanically ventilated adult patients. There has been increasing interest in the clinical application of dexmedetomidine in the pediatric population. Onset occurred in minutes with a peak effect at 90 minutes. Our Experience On the basis of this information, we have used intranasal dexmedetomidine as a premedication in a number of patients. Since this drug has a neutral pH it is virtually painless when given intranasally.
Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.
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