Comparison of the Efficacy of Two Doses of Intranasal Atomized Dexmedetomidine as Premedication for Parental Separation Anxiety in Children Undergoing Elective Surgery

TL;DR

A study compared two doses of a nasal sedative in children before surgery and found the higher dose more effective at reducing anxiety and improving outcomes.

Contribution

The study provides new evidence that a higher dose of intranasal dexmedetomidine is more effective for preoperative anxiety in children.

Findings

The 2 µg/kg dose showed significantly better sedation and lower separation anxiety scores.

Higher dose improved mask acceptance and reduced postoperative pain and agitation.

Both doses maintained stable hemodynamics without adverse events.

Abstract

Background

Preoperative anxiety in children is a common challenge associated with adverse perioperative outcomes, including poor parental separation, difficult mask acceptance, and emergence delirium. Dexmedetomidine, an alpha-2 adrenergic agonist, is increasingly explored as a noninvasive intranasal premedication.

Objective

This study compared the efficacy of two intranasal doses of dexmedetomidine (1 µg/kg vs. 2 µg/kg) in reducing separation anxiety and improving perioperative conditions in children undergoing elective surgery.

Methods

A prospective randomized controlled trial was conducted on 50 children aged between one and six years, American Society of Anesthesiologists (ASA) I-II, scheduled for elective surgery under general anesthesia. Participants were randomly assigned to receive either 1 µg/kg (Group I) or 2 µg/kg (Group II) of atomized intranasal dexmedetomidine 30 minutes before induction. Sedation Score (SS), Parental Separation Anxiety Score (PSAS), mask acceptance, hemodynamic parameters, postoperative pain (Face, Legs, Activity, Cry, Consolability (FLACC) scale), and emergence agitation (Emergence Agitation Scale (EAS)) were assessed.

Results

Group II demonstrated significantly better sedation at 30 minutes, a lower PSAS, improved mask acceptance, and reduced postoperative pain and emergence agitation (p<0.001). Hemodynamics remained stable in both groups without adverse events.

Conclusion

Intranasal dexmedetomidine 2 µg/kg provided superior preoperative sedation, smoother parental separation, better mask acceptance, and reduced postoperative discomfort compared with 1 µg/kg, without significant side effects.

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