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Comparison of Intranasal Dexmedetomidine with Intranasal Clonidine as a Premedication in Surgery

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Abstract

Objectives

To compare effectiveness of intranasal dexmedetomidine and clonidine as anxiolytics and sedatives in pediatric patients undergoing various surgeries.

Methods

This double blind randomized placebo controlled study was conducted on 105 surgical patients of American Society of Anesthesiologist (ASA) physical status І-ІІ, aged between 2 and 9 y in a tertiary-care hospital (February 2014 to September 2015). Participants were randomly allocated to three groups to receive either intranasal dexmedetomidine 2 μg/kg (Group І) or intranasal clonidine 3 μg/kg (Group ІІ) or intranasal saline 0.5 ml (Group ІІІ). The primary outcome measure was proportion of patients with satisfactory anxiolysis and sedation at 30 min after drug administration. Secondary outcome measures included time taken to achieve Aldrete score of 9 and number of doses of rescue analgesia required in 12 h after surgery.

Results

Satisfactory anxiolysis was achieved by 88.5% in Group І vs. 60% in Group ІІ (p = 0.001) and satisfactory sedation by 57.1% in Group І vs. 25.7% in Group ІІ (p = 0.001) 30 min after premedication. Rescue analgesia requirement was significantly less in Group І as compared to Group ІІ (p = 0.001) while time taken to achieve Aldrete score was comparable between the study groups (p = 0.185).

Conclusions

Intranasal dexmedetomidine is a better anxiolytic and sedative as compared to clonidine. Postoperative analgesic requirement was also significantly decreased after intranasal dexmedetomidine. Thus, it can be preferred as compared to clonidine for premedication in pediatric surgical patients.

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References

  1. Kain Z, Sevarino F, Rinder C. The preoperative behavioral stress response: does it exist? [abstract] Anesthesiology. 1999;91:A742.

  2. Kain ZN, Mayes LC, O′Connor TZ, Cicchetti DV. Preoperative anxiety in children, predictors and outcome. Arch Pediatr Adolesc Med. 1996;150:1238–45.

    Article  CAS  PubMed  Google Scholar 

  3. Chernow B, Alexander HR, Smallridge RC, et al. Hormonal responses to graded surgical stress. Arch Intern Med. 1987;147:1273–8.

    Article  CAS  PubMed  Google Scholar 

  4. Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during induction of anaesthesia and postoperative behaviour outcomes. Anesth Analg. 1999;88:1042–7.

    Article  CAS  PubMed  Google Scholar 

  5. Kain ZN, Hofstadter MB, Mayes LC, et al. Midazolam: effects on amnesia and anxiety in children. Anesthesiology. 2000;93:676–84.

    Article  CAS  PubMed  Google Scholar 

  6. Weber F, Wulf H, el Saeidi G. Premedication with nasal S-ketamine and midazolam provides good conditions for induction of anaesthesia in preschool children. Can J Anaesth. 2003;50:470–5.

    Article  PubMed  Google Scholar 

  7. Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: a comparsion of intranasal dexmedetomidine versus oral midazolam. Saudi J Anaesth. 2011;5:387–91.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mitra S, Kazal S, Anand LK. Intranasal clonidine vs. midazolam as premedication in children: a randomized controlled trial. Indian Pediatr. 2014;51:113–8.

    Article  PubMed  Google Scholar 

  9. Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH. A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg. 2007;105:374–80.

    Article  CAS  PubMed  Google Scholar 

  10. Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB. The Yale preoperative anxiety scale: how does it compare with a "gold standard"? Anesth Analg. 1997;85:783–8.

    Article  CAS  PubMed  Google Scholar 

  11. Wang SS, Zhang MZ, Sun Y, et al. The sedative effects and attenuation of cardiovascular and arousal responses during anaesthesia induction and intubation in pediatric patients: a randomized comparison between two different doses of preoperative intranasal dexmedetomidine. Pediatr Anaesth. 2014;24:275–81.

  12. Talon MD, Woodson LC, Sherwood ER, Aarsland A, McRae L, Benham T. Intranasal dexmedetomidine premedication is comparable with midazolam in burn children undergoing reconstructive surgery. J Burn Care Res. 2009;30:599–605.

  13. Walsh DL, Steiner JW, Hoang SQ, Pop RB, Szmuk P. Use of intranasal dexmedetomidine for preoperative sedation in fifteen pediatric patients. Anesthesiology. 2008;109:A1378.

    Google Scholar 

  14. Mukherjee S, Ray M, Ray A, Khanra M, Mandal PK, Pal R. Clonidine premedication for paediatric patient: a comparison of the oral and nasal route. J Anesth Clin Pharmacol. 2010;26:319–22.

    CAS  Google Scholar 

  15. Bucklin B, Eisenach JC, Tucker B. Pharmacokinetics and dynamic studies of intrathecal, epidural and intravenous dexmedetomidine. Anaesthesiology. 1991;75:662.

    Article  Google Scholar 

  16. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Aldrete JA. The post anaesthesia recovery score revisited. J Clin Anesth. 1995;7:89–90.

    Article  CAS  PubMed  Google Scholar 

  18. Norden J, Hannallah R, Getson P, O’Donnell R, Kelliher G, Walker N. Reliability of objective pain scale in children. Anesth Analg. 1996;72:S199.

    Google Scholar 

  19. Georgitis JW. Nasal atropine sulfate: efficacy and safety of 0.050% and 0.075% solutions for severe rhinorrhea. Arch Otolaryngol Head Neck Surg. 1998;124:916–20.

    Article  CAS  PubMed  Google Scholar 

  20. Iirola T, Vilo S, Manner T, et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67:825–31.

    Article  CAS  PubMed  Google Scholar 

  21. Yuen VM, Hui TW, Irwin MG, Yuen MK. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trial. Anesth Analg. 2008;106:1715–21.

    Article  CAS  PubMed  Google Scholar 

  22. Phillips J. Intranasal dexmetedomidine. Available at: http://blog.pedsedation.org/p50. Accessed on 22nd April 2016.

  23. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382–94.

    Article  CAS  PubMed  Google Scholar 

  24. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125–33.

    Article  CAS  PubMed  Google Scholar 

  25. Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Steal-induction after clonidine premedication: a comparison of the oral and nasal route. Pediatr Anesth. 2007;17:230–4.

    Article  Google Scholar 

  26. Yuen VM. Dexmedetomidine: perioperative applications in children. Pediatr Anesth. 2010;20:256–64.

    Article  Google Scholar 

  27. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol. 2008;21:457–61.

    Article  PubMed  Google Scholar 

  28. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Baylor Univ Med Cent). 2001;14:13–21.

    CAS  Google Scholar 

  29. Nishina K, Mikawa K, Maekawa N, Takao Y, Obara H. Clonidine decreases the dose of thiamylal required to induce anesthesia in children. Anesth Analg. 1994;79:766–8.

    Article  CAS  PubMed  Google Scholar 

  30. Nishina K, Mikawa K, Maekawa N, Obara H. The efficacy of clonidine for reducing perioperative haemodynamic changes and volatile anaesthetic requirements in children. Acta Anaesthesiol Scand. 1996;40:746–51.

    Article  CAS  PubMed  Google Scholar 

  31. Gil DW, Cheevers CV, Kedzie KM, et al. Alpha-1-adrenergic receptor agonist activity of clinical alpha-adrenergic receptor agonists interferes with alpha-2-mediated analgesia. Anesthesiology. 2009;110:401–7.

    CAS  PubMed  Google Scholar 

  32. Solanki SL, Bharti N, Batra YK, Jain A, Kumar P, Nikhar SA. The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivicaine, in trauma patients undergoing lower limb surgery: a randomised, double-blind study. Anaesth Intensive Care. 2013;41:51–6.

    CAS  PubMed  Google Scholar 

  33. Eisenach JC, De Kock M, Kinschaw. α2-adrenoceptor agonists for regional anaesthesia. A clinical review of clonidine. Anesthesiology. 1996;85:655–74.

    Article  CAS  PubMed  Google Scholar 

  34. Primosch RE, Guelmann M. Comparison of drops versus spray administration of intranasal midazolam in two- and three-year-old children for dental sedation. Pediatr Dent. 2005;27:401–8.

    PubMed  Google Scholar 

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Acknowledgments

The authors thank Baltej Singh for assistance in data analysis and Dr. Anupama Gupta for going through the manuscript.

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Authors and Affiliations

  1. Department of Anesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, 151203, India

    Gurkaran Kaur Sidhu, Seema Jindal, Gurpreet Singh, Kewal Krishan Gupta & Shobha Aggarwal

  2. Department of Anesthesia, Adesh Medical College and Hospital, Mohri, Shahbad, India

    Gurpreet Kaur

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  1. Gurkaran Kaur Sidhu
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  2. Seema Jindal
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Correspondence to Gurkaran Kaur Sidhu.

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GKS, SJ and GK: Conception and design of this work as well as writing of the manuscript. GS, KKG and SA: Helped in interpretation of data and editing of the manuscript. GKS will act as guarantor for the paper.

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Sidhu, G.K., Jindal, S., Kaur, G. et al. Comparison of Intranasal Dexmedetomidine with Intranasal Clonidine as a Premedication in Surgery. Indian J Pediatr 83, 1253–1258 (2016). https://doi.org/10.1007/s12098-016-2149-4

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  • DOI: https://doi.org/10.1007/s12098-016-2149-4

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