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A Comparative Evaluation of Oral Clonidine, Dexmedetomidine, and Melatonin as Premedicants in Pediatric Patients Undergoing Subumbilical Surgeries

A Comparative Evaluation of Oral Clonidine, Dexmedetomidine, and Melatonin as Premedicants in... AbstractIntroductionSedative premedication is the mainstay of pharmacological therapy in children undergoing surgeries. This study compares preoperative melatonin, clonidine, and dexmedetomidine on sedation, ease of anesthesia induction, emergence delirium, and analgesia.Materials and MethodsOne hundred and five children, 3–8 years, either sex, ASA I/II, posted for infraumbilical surgery, randomized to receive clonidine 5 mcg/kg (Group C), dexmedetomidine 3 mcg/kg (Group D), and melatonin 0.2 mg/kg (Group M) 45 minutes before surgery. Preoperative Sedation/Anxiety and Child–Parent Separation Score (CPSS) were assessed. Identical anesthesia technique was utilized. Emergence delirium (Watcha score) and postoperative pain (Objective Pain Scale score) were monitored postoperatively.ResultsPatients were demographically comparable. Sedation score >Grade 3 was absent. Grades 1/2/3 were present in 10/19/6 (Group C), 2/26/7 (Group D), and 7/26/2 (Group M). Grade 1 CPSS was present in 42.6% (Group C), 37.1% (Group D), and 28.6% (Group M). Pediatric Anesthesia Behavior Score (PABS) was comparable between Groups C and D (p = 0.224; 95% CI −0.090 to 0.604) and Groups C and M (p = 0.144; 95% CI −0.633 to 0.061) while PABS was better in Group D compared to Group M (p = 0.0007; 95% CI −0.890 to −0.195). Watcha scores were 33/2/0/0 (Group C), 34/1/0/0 (Group D), and 32/2/1/0 (Group M) immediately after extubation. Scores were 31/4/0/0 (Group C), 33/2/0/0 (Group D), and 31/4/0/0 (Group M) at 30 minutes and 28/7/0/0 (Group C), 29/6/0/0 (Group D), and 24/11/0/0 (Group M) at 1 hour. The scores were comparable (p > 0.05). Objective Pain Scale scores were comparable between Groups C and D and Groups C and M (p > 0.05). Lower scores were present in Group D compared to M (p = 0.023).ConclusionMelatonin, clonidine, and dexmedetomidine are efficacious for producing preoperative sedation, reducing anxiety, postoperative pain, and emergence delirium. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Romanian Journal of Anaesthesia and Intensive Care de Gruyter

A Comparative Evaluation of Oral Clonidine, Dexmedetomidine, and Melatonin as Premedicants in Pediatric Patients Undergoing Subumbilical Surgeries

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Publisher
de Gruyter
Copyright
© 2020 Syed T Ali et al., published by Sciendo
eISSN
2502-0307
DOI
10.2478/rjaic-2020-0006
Publisher site
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Abstract

AbstractIntroductionSedative premedication is the mainstay of pharmacological therapy in children undergoing surgeries. This study compares preoperative melatonin, clonidine, and dexmedetomidine on sedation, ease of anesthesia induction, emergence delirium, and analgesia.Materials and MethodsOne hundred and five children, 3–8 years, either sex, ASA I/II, posted for infraumbilical surgery, randomized to receive clonidine 5 mcg/kg (Group C), dexmedetomidine 3 mcg/kg (Group D), and melatonin 0.2 mg/kg (Group M) 45 minutes before surgery. Preoperative Sedation/Anxiety and Child–Parent Separation Score (CPSS) were assessed. Identical anesthesia technique was utilized. Emergence delirium (Watcha score) and postoperative pain (Objective Pain Scale score) were monitored postoperatively.ResultsPatients were demographically comparable. Sedation score >Grade 3 was absent. Grades 1/2/3 were present in 10/19/6 (Group C), 2/26/7 (Group D), and 7/26/2 (Group M). Grade 1 CPSS was present in 42.6% (Group C), 37.1% (Group D), and 28.6% (Group M). Pediatric Anesthesia Behavior Score (PABS) was comparable between Groups C and D (p = 0.224; 95% CI −0.090 to 0.604) and Groups C and M (p = 0.144; 95% CI −0.633 to 0.061) while PABS was better in Group D compared to Group M (p = 0.0007; 95% CI −0.890 to −0.195). Watcha scores were 33/2/0/0 (Group C), 34/1/0/0 (Group D), and 32/2/1/0 (Group M) immediately after extubation. Scores were 31/4/0/0 (Group C), 33/2/0/0 (Group D), and 31/4/0/0 (Group M) at 30 minutes and 28/7/0/0 (Group C), 29/6/0/0 (Group D), and 24/11/0/0 (Group M) at 1 hour. The scores were comparable (p > 0.05). Objective Pain Scale scores were comparable between Groups C and D and Groups C and M (p > 0.05). Lower scores were present in Group D compared to M (p = 0.023).ConclusionMelatonin, clonidine, and dexmedetomidine are efficacious for producing preoperative sedation, reducing anxiety, postoperative pain, and emergence delirium.

Journal

Romanian Journal of Anaesthesia and Intensive Care – de Gruyter

Published: Jul 1, 2020

Keywords: Premedication; drugs-melatonin; clonidine; dexmedetomidine

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