Comparison of Nebulized Fentanyl, Midazolam and Dexmedetomidine as a Premedication in Pediatric Dental Surgeries
Study Details
Study Description
Brief Summary
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The preoperative time can be traumatic for young children undergoing surgery. Pediatric anesthesiologists act strongly to decrease distress for children in the operating room (OR) and to provide a smooth induction of anesthesia.
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Many drugs have been used as premedication to decrease anxiety , facilitate smooth induction and easy separation of children from their parents.
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This study was designed to evaluate and compare the effect and safety of nebulized either fentanyl, midazolam or nebulized dexmedetomidine as a sedative premedication prior to general anesthesia (GA) in outpatient pediatric dental surgeries.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| N/A |
Detailed Description
The preoperative time can be traumatic for young children undergoing surgery. Pediatric anesthesiologists act strongly to decrease distress for children in the operating room (OR) and to provide a smooth induction of anesthesia(1). Parentral separation and needle injection increase preoperative anxiety. Preoperative stress response stimulates the sympathetic, parasympathetic, and endocrine systems, leading to an increase in heart rate (HR), blood pressure, and cardiac excitability(2,3) . Dental procedures are assiociated by high rate of fear and anxiety in children (4).
Many drugs have been used as premedication to decrease anxiety , facilitate smooth induction and easy separation of children from their parents. The ideal premedication especially in children must be acceptable with rapid onset ,minimal side effects and with rapid postoperative recovery and return to alertness (5,6).
Fentanyl is a potent analgesic opioid with a rapid onset, and short duration of action (7). Midazolam is a short-acting benzodiazepine that has anxiolytic, amnestic, hypnotic, anticonvulsant and muscle relaxant actions (8,9). Dexmedetomidine is a selective α-2 adrenergic agonist that has both sedative and analgesic effects (10-12)
Preoperative sedation in children is usually administered via the rectal, oral sublingual, and intranasal routes with different degrees of patient acceptance.(13-18). Nebulized drug is an alternative method of sedation that is relatively easy to set up, without need for venipuncture, and is associated with high bioavailability of the drug (19,20).
This study was designed to evaluate and compare the effect and safety of nebulized either fentanyl, midazolam or nebulized dexmedetomidine as a sedative premedication prior to general anesthesia (GA) in outpatient pediatric dental surgeries. The primary end point is the time of sedation and level of sedation when the child is first seen in the operating room(OR) 30 minutes after using studied drugs, based on the Modified Observer's Assessment of Alertness/Sedation Scale(19). The secondary end points are parentral separation, tolerance to mask induction, reaction to intravenous cannulation, hemodynamic changes( systolic blood pressure, diastolic blood pressure and heart rate), sedation at emergence and wake-up behavior.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: fentanyl patients will be given nebulized fentanyl 2μg/kg body weight 30 min before surgery |
Drug: fentanyl
nebulized fentanyl 2μg/kg body weigh
Other Names:
|
| Active Comparator: midazolam The patients will be given nebulized midazolam 0.2 mg/kg body weight 30 min before surgery. |
Drug: midazolam
nebulized midazolam 0.2 mg/kg body weight 30 min before surgery.
Other Names:
|
| Active Comparator: dexmedetomidine The patients will be given nebulized dexmedetomidine 2 μg/kg body weight 30 min before surgery. |
Drug: dexmedetomidine
nebulized dexmedetomidine 2 μg/kg body weight 30 min before surgery.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- of onset of sedation [Baseline (before surgery)]
onset of sedation based on the Modified Observer's Assessment of Alertness/Sedation Scale 6Appears alert and awake, responds readily to name spoken in normal tone 5 Appears asleep but responds readily to name spoken in normal tone 4 Lethargic response to name spoken in normal tone 3 Responds only after name is called loudly or repeatedly 2 Responds only after mild prodding or shaking 1 Does not respond to mild prodding or shaking 0 Does not respond to noxious stimulus
Secondary Outcome Measures
- Heart rate [Baseline (before surgery) and intraoperative]
hemodynamic changes
- systolic and diastolic blood pressure [Baseline (before surgery) and intraoperative]
hemodynamic changes
Eligibility Criteria
Criteria
Inclusion Criteria:
- Parent acceptance.Children 2-6 years old of either sex.12-18 kg body weight. american society of anesthesiologist I-II.outpatients dental surgeries under general anesthesia.
Exclusion Criteria:
Difficult airway .central nervous system dysfunction.Advanced Cardiovascular ,liver, renal diseases. Allergy to the drugs under study. Patients with any intranasal pathology or congenital anomaly.Patient refusal to take the inhaled premeditation.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Faculty of Medicine,Zagazig University | Zagazig | Zagazig, Elsharkia,egypt | Egypt | 44519 |
Sponsors and Collaborators
- Zagazig University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 5742-3-12-2019