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.