[Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial].
BACKGROUND
Dexmedetomidine is a pharmacological option for sedation in children. In this study, the efficacy of intranasal dexmedetomidine to reduce preoperative anxiety in pediatric patients is compared with that of oral midazolam.


METHODS
A prospective, randomized, double-blind, controlled trial was conducted on children 2-12 years of age, randomly assigned to one of the following two groups: group A received premedication with oral midazolam and intranasal placebo, group B received intranasal dexmedetomidine and oral placebo. Anxiety was assessed with the modified Yale scale, and a risk analysis and number needed to treat was performed.


RESULTS
A total of 108 patients were included, 52 (48.1%) treated with dexmedetomidine, and 56 (51.9%) with midazolam. Anxiety was less frequent in the dexmedetomidine group at 60minutes (P=.001), induction (p=.04), and recovery (P=.0001). Risk analysis showed that dexmedetomidine reduced the risk of anxiety by 28% (RAR=0.28, 95% CI; 0.12 to 0.43) and to prevent one case of anxiety, four patients need to be treated with intranasal dexmedetomidine (NNT=4, 95% CI: 3-9).Changes in heart rate, mean arterial pressure, and oxygen saturation, were statistically significant in the dexmedetomidine group, with no clinical consequences. There were no cases of bradycardia, hypotension or oxygen desaturation.


CONCLUSIONS
Intranasal dexmedetomidine premedication is more effective than oral midazolam to reduce preoperative anxiety in pediatric patients.
Departamento de Medicina y Nutrición, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, León, Guanajuato, México; Servicio de Enseñanza e Investigación, Hospital Regional Salamanca de Petróleos Mexicanos, Salamanca, Guanajuato, México. Electronic address: blinares70@ugto.mx.
B
B
Linares Segovia
Servicio de Enseñanza e Investigación, Hospital Regional Salamanca de Petróleos Mexicanos, Salamanca, Guanajuato, México.
M A
MA
García Cuevas
Servicio de Enseñanza e Investigación, Hospital Regional Salamanca de Petróleos Mexicanos, Salamanca, Guanajuato, México.
I L
IL
Ramírez Casillas
Servicio de Enseñanza e Investigación, Hospital Regional Salamanca de Petróleos Mexicanos, Salamanca, Guanajuato, México.
J F
JF
Guerrero Romero
Servicio de Enseñanza e Investigación, Hospital Regional Salamanca de Petróleos Mexicanos, Salamanca, Guanajuato, México.
I
I
Botello Buenrostro
Departamento de Medicina y Nutrición, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, León, Guanajuato, México.
R
R
Monroy Torres
Departamento de Medicina y Nutrición, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, León, Guanajuato, México.
X S
XS
Ramírez Gómez
D000281:Administration, Intranasal; D000284:Administration, Oral; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D011229:Preanesthetic Medication; D011446:Prospective Studies
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam
Ansiedad; Anxiety; Dexmedetomidina; Dexmedetomidine; Midazolam; Sedantes; Sedative