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Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial

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A Letter to the Editor to this article was published on 02 August 2020

A Letter to the Editor to this article was published on 14 May 2020

Abstract

Purpose

Emergence delirium (ED) is common in children after sevoflurane anesthesia and should be prevented for patient safety. A prospective, double-blind, randomized, controlled study was performed to compare the efficacy of minimal dosage of midazolam versus dexmedetomidine to prevent ED in children undergoing tonsillectomy.

Methods

Seventy children aged 24 months to 12 years were allocated to receive midazolam (0.03 mg/kg) or dexmedetomidine (0.3 µg/kg) 5 min before the end of surgery. The incidence and severity of ED were assessed using a four-point scale and the pediatric anesthesia emergence delirium scale, respectively. The emergence time and postoperative pain scores were also evaluated.

Results

The incidence of ED was 31.3% in the midazolam group and 26.5% in the dexmedetomidine group (P = 0.668). The severity of ED was similar in both groups (9.6 ± 5.8 in the midazolam group, vs. 8.1 ± 5.9 in the dexmedetomidine group, P = 0.299). The emergence time was comparable in the two groups [11.0 (8.3–13.8) min in midazolam group vs. 12.0 (10.0–13.5) min in dexmedetomidine group (P = 0.218)]. Postoperative pain score was higher in the midazolam group [0 (0–1)] than in the dexmedetomidine group [0 (0–0)] (P = 0.011).

Conclusion

Dexmedetomidine and midazolam at single minimum dosages had equal effectiveness to prevent ED in children without delaying emergence time, when administered at the end of surgery. With regards to postoperative analgesic efficacy, although dexmedetomidine showed statistically significant higher analgesic effect than midazolam, further clinical investigations are needed to validate our findings.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea

    Eun-Ah Cho, Yun-Byeong Cha, Jae-Geum Shim, Jin-Hee Ahn, Sung Hyun Lee & Kyoung-Ho Ryu

  2. Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea

    Eun-Ah Cho

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  1. Eun-Ah Cho
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  2. Yun-Byeong Cha
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Cho, EA., Cha, YB., Shim, JG. et al. Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. J Anesth 34, 59–65 (2020). https://doi.org/10.1007/s00540-019-02705-6

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  • DOI: https://doi.org/10.1007/s00540-019-02705-6

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