Dexmedetomidine outperforms midazolam as anti-anxiety premedication for kids undergoing tonsillectomy

A new study published in JAMA Network Open found that premedication with intranasal dexmedetomidine was associated with a reduced incidence of Perioperative respiratory adverse events in children undergoing tonsillectomy and adenoidectomy. Dexmedetomidine outperforms midazolam as anti-anxiety premedication for children aged 0 to 12 years undergoing elective tonsillectomy.

The most common complications during pediatric anesthesia are Perioperative respiratory adverse events (PRAEs) which may be affected by the administration of preoperative sedatives. As it is unclear if preoperative sedatives such as midazolam and dexmedetomidine have a protective effect against PRAEs, researchers from China conducted a study to evaluate the effect of intranasal dexmedetomidine or midazolam on the occurrence of PRAEs. 

A single-center, double-blind, randomized clinical trial was undertaken from October 2020 to June 2021 at Children's Hospital of Xuzhou Medical University, Xuzhou, China. The subjects were children aged 0 to 12 years undergoing elective tonsillectomy and adenoidectomy. The participants were randomly assigned to 3 groups. They were the Midazolam group where they received intranasal midazolam of 0.1 mg/kg, the dexmedetomidine group where 2.0 μg/kg intranasal dexmedetomidine was administered for premedication, and a normal saline group receiving 0.9% saline for control. The difference in the incidence of PRAEs among the 3 groups was taken as the primary outcome of the measurement.  The frequency of the individual PRAEs, including the incidence of such events during the induction and recovery periods, postoperative emergence delirium, postoperative pain score, sedation success rate, and heart rate values were the secondary outcomes. 

Results: 

• A total of 384 children with a median age of 7 years were enrolled and randomized.
• Of these there were 227 boys [59.1%].
• 373 data sets were available for intention-to-treat analysis with 124 children in the midazolam group, 124 children in the dexmedetomidine group, and 125 children in the normal saline group.
• After adjusting the data for age, sex, American Society of Anesthesiologists' physical status, body mass index, obstructive sleep apnea, upper respiratory tract infection, and passive smoking, it was found that children in the midazolam group experienced more PRAEs than those in the normal saline group, whereas the dexmedetomidine group had a significantly lower PRAEs incidence than the normal saline group.
• Compared with the dexmedetomidine group, the midazolam group had a higher risk of PRAEs, but no other serious clinical adverse events were observed. 

Thus, the researchers concluded that there was a reduced incidence of PRAEs in the intranasal dexmedetomidine group than in intranasal midazolam. They further suggested that further going on, anesthesiologists should consider using intranasal dexmedetomidine for sedation in children undergoing tonsillectomy and adenoidectomy. 

For the full article, click here: 10.1001/jamanetworkopen.2022.25473 

Shen F, Zhang Q, Xu Y, et al. Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(8):e2225473. Published 2022 Aug 1.