الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
After getting the approval of the institutional ethical committee of Minia University Hospital, written informed consent was given to 60 parents of pediatric patients aged from 4 to 10 years old, of American Society of Anaesthesiologists (ASA) class I, undergoing lower abdominal surgery under general anesthesia in the period from August 2022 to May 2023. Before deciding on the procedures, all patients were evaluated with respect to their chronic diseases, psychological problems, and developmental delay.
This study aimed to evaluate and compare the efficacy, safety, and anxiolytic effect of preoperative infusion of dexmedetomidine versus midazolam in pediatric patients undergoing lower abdominal surgeries.
Measuring the changes in preoperative and postoperative scores of anxieties and sedation were the main outcomes in children receiving dexmedetomidine or midazolam infusion as a premedication in lower abdominal surgery.
The patients were randomly allocated into two parallel equal groups of 30 patients in each group by using a computer-generated random number table. Anaesthesiologists not involved in the study prepared the drug used. The surgeons, anaesthesiologists, patients, and parents were blind to group allocation.
group I (m) received premedication of midazolam (0.08 mg/kg) infusion in 20 mL of normal saline over 10 minutes.
group II (d) received premedication of dexmedetomidine (0.5 µg/kg) infusion in 20 mL of normal saline over 10 minutes.
All patients were assessed in terms of:
1. Preoperative period:
a) Sedation status.
b) Anxiety.
c) Hemodynamic changes include heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure.
d) Oxygen saturation and respiratory rate.
e) Parent separation.
2. Intraoperative period:
a) Hemodynamic changes: including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure.
b) Mask acceptance.
c) Anaesthetic time.
d) Operation time.
e) Requirement of analgesia.
f) Adverse events include hypotension and bradycardia.
3. Postoperative period:
a) Hemodynamic parameters: including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure.
b) Respiratory rate and oxygen saturation.
c) Sedation.
d)Agitation.
e) Pain.
f) First analgesic request.
j) Time from discharge from the recovery room to the ward.
h) Parent satisfaction.
i) The incidence of any side effects including shivering, hypoxia, hypotension, bradycardia, nausea, and vomiting.
Our results recorded that the two studied groups were comparable as regard the mean age, weight, gender distribution, ASA classification, anesthetic duration, surgery duration, recovery duration, and type of surgery.
As regard preoperative anxiety, preoperative infusion of both midazolam and dexmedetomidine resulted in a significant reduction in anxiety scale in both groups but there was no statistically significant difference between the two studied groups at any recorded time.
As regard preoperative sedation, there was no statistically significant difference when comparing the two studied groups, there was a significant decrease in sedation score inside each group after infusion of premedication.
As regard postoperative sedation, there was a statistically significant difference when comparing the two studied groups. The postoperative sedation score in the two studied groups was significantly higher in group II (D) when compared to group I (m) during the postoperative period.
As regard postoperative agitation, there was a statistically significant difference when comparing the two studied groups. The agitation score was significantly better in group II (d) when compared to group I (m) during the postoperative period.
As regard hemodynamic, there were statistically significant decreases in heart rate and blood pressure after dexmedetomidine infusion with no significant change after midazolam infusion.
As regard respiratory rate and oxygen saturation, there was no statistically significant difference when comparing the two studied groups.
As regard parent separation, there was a statistically significant difference when comparing the two studied groups more after dexmedetomidine infusion, most of the patients in the two studied groups were calm and cooperative during separation.
As regard mask acceptance, there was no statistically significant difference when comparing the two studied groups, All the patients showed satisfactory response to the premedication.
As regard postoperative pain, there was a statistically significant difference when comparing the two studied groups. The FLACC pain score was significantly better in group II (d) when compared to group I (m).
As regard analgesic request and patients who needed rescue analgesia, there was no statistically significant difference when comparing the two studied groups.
As regard parent satisfaction, there was a statistically significant difference when comparing the two studied groups. Parent satisfaction caused by dexmedetomidine infusion was better than that of midazolam infusion.
As regard adverse events, there was no statistically significant difference when comparing the two studied groups.