Effect of ORAL DEXMEDETOMIDINE, KETAMINE, OR MIDAZOLAM as Preioperative Medications.
Status:
Recruiting
Trial end date:
2024-03-01
Target enrollment:
Participant gender:
Summary
Anxiety preceding surgery results in hemodynamic instability, metabolic side effects,
increased post-operative pain, and agitation during emergence. Therefore, pharmacological
interventions are used to reduce pre-operative anxiety and enhance anesthetic induction
without delaying recovery. The premedication must be administered in a manner that is safe,
painless, and without significant adverse effects. [1,2]
. In children, the incidence of emergency agitation or delirium after general anesthesia
ranges from 10% to 80% and significantly increases the incidence of other complications after
anesthesia, such as self-injury, prolonged postanesthesia care unit (PACU) stay, frustration
of parents and care providers, etc.[3]
. Numerous pharmacological and non-pharmacological techniques, including sedative
premedication, parental presence, and training programs for participants and their parents,
have been investigated to reduce anxiety and enhance compliance during anesthesia induction.
[4]
. An ideal premedication prescription should sedate a child to facilitate separation from
parents, thus simplifying anesthesia induction and creating a pleasant surgical experience
for both children and parents. [5]
. Anxiolysis is the major objective of premedication in children, as it facilitates
separation from parents and facilitates the induction of anesthesia.
Premedication may also induce amnesia, the prevention of physiologic stress, vagolysis, a
decrease in total anesthetic requirements, a lower likelihood of aspiration, decreased
salivation and secretions, antiemesis, and analgesia. All drugs have the potential to make
people sleepy and slow their breathing, so they must be given with extreme care and closely
watched. [6]
. Ketamine is a useful sedative and analgesic for preventing preoperative anxiety in
children; it exerts its analgesic effect through the reversible antagonist action of
N-methyl-D-aspartate receptors. It has analgesic and sedative effects in different doses of
administration. Ketamine is often administered orally and is αreported to be safe and
effective in pediatric patients. [7,8,9,10]
. An effective sedative and analgesic with minimal respiratory depressive effects is
dexmedetomidine, an α2-adrenoceptor agonist. It also reduces the hemodynamic stress response
due to its sympatholytic effect. These characteristics make it a possible anesthetic
premedication. [11]
. Midazolam, a water-soluble benzodiazepine, is commonly used as a preanesthetic medicine in
children due to its several favorable effects: sedation, anxiolysis, antegrade amnesia, rapid
onset, and brief duration of action. [12]
. Adenoidectomy and/or tonsillectomy are the most common surgical procedures done on
children. [13]
. Hence, the present study will be conducted to objectively evaluate, the perioperative
effects of oral dexmedetomidine, ketamine, or midazolam premedication in patients undergoing
adenotonsillectomy.