The effect of dexmedetomidine nebulization as a premedication prior to peripheral intravenous access in pediatric patients and its effect on separation anxiety score and acceptance to intravenous cannulation score.

Abstract

Introduction Sedation in pediatric patients is one of the many chal- lenges in anesthesia practice. Premedication helps facili- tate smooth separation from the parents and ease the in- duction of anesthesia. Dexmedetomidine is a selective α- 2 adrenoceptor agonist that provides sedation, anxiolysis and analgesic effects without causing respiratory depres- sion. Nebulized dexmedetomidine application is a relatively non‐invasive, convenient and easy route of administra- tion that is well-tolerated by pediatric patients. Previous studies have established that intranasal dexmedetomidine effectively produced sedation, improved cooperation during invasive procedures such as intravenous cannula- tion and ameliorated separation anxiety in children with a dose range of 1-2 mcg/kg. This study was designed to evaluate the effect of dexme- detomidine nebulization as a premedication prior to pe- ripheral intravenous access in pediatric patients and its effect on ease of separation from the parent and ac- ceptance of intravenous cannulation. Materials and Methods A total of 52 children, aged 2 to 6 years and American Society of Anesthesiologists’ (ASA) physical status clas- sification of I–II, scheduled for elective outpatient diag- nostic procedure were randomly allocated to receive ei- ther nebulized dexmedetomidine 2mcg/kg (Experimental group) or no interventional premedication (Control group). Sedation state was evaluated every 15 minutes af- ter premedication and behavioral state was assessed dur- ing separation from their parents and peripheral intrave- nous cannulation. The primary endpoint was the ac- ceptance of the venous cannulation and physical separa- tion from the parent. Results Both groups were comparable with respect to demo- graphic data (age, gender and comorbidities), weight, du- ration of procedure and duration of anesthesia. Vital signs were maintained within the normal range in both the groups during the whole peri-operative period, with nosignificant statistical difference between the two groups Intravenous cannulation acceptance was statistically sig- nificant between the groups, and was satisfactory in 18 patients (69.2%) in the experimental group but only in 6 patients (23.1%) in the control group. Likewise, ease of parental separation was statistically significant between the groups, and was satisfactory in 20 patients (76.9%) in the Experimental group and in 13 patients (50.0%) in Control group. Conclusion The use of nebulized dexmedetomidine (2mcg/kg) pro- duces satisfactory sedative effects that facilitate ease of successful intravenous cannulation, ease of children sep- aration from their parents, and is less likely to be associ- ated with perioperative adverse events.

Keywords

• dexmedetomidine
• nebulized premedication
• pediatric
• intravenous cannulation