Comparison of Sublingual and Nasal Applications of Dexmedetomidine Premedication in Pediatric Patients

Abstract

Introduction:Alpha-2 adrenergic agonists are used for premedication in the pediatric population to reduce separation anxiety and achieve smooth induction. The clinical effects of clonidine are similar in both oral and nasal routes. However, oral dexmedetomidine is not preferred because of its poor bioavailability. The objective of this study was to retrospectively evaluate the effects of nasal and sublingual dexmedetomidine premedication in children.Methods:Sixty-seven patients aged between 2-6 years who underwent elective surgery and received sublingual 2-μg kg-1 or intranasal 2-μg kg-1 dexmedetomidine premedication one hour before induction of anesthesia were retrospectively evaluated. Heart rate, peripheral oxygen saturation and anxiety scores of patients were compared in 10-minute intervals starting before premedication and up to the operating room. Drug acceptance, parental separation and facemask acceptance were also compared.Results:There was no significant difference between the two groups in terms of demographic characteristics. There was no significant difference in terms of hemodynamic data, including heart rate, respiratory rate and SpO2. After sixty minutes of premedication, anxiolysis, mask acceptance and parental separation were comparable in two groups. The median sedation level of intranasal group was significantly higher than sublingual group 60 minutes after drug administration [3 (3- 3) vs 3 (1-3), respectively p=0.006]. However, the number of children with satisfactory sedation levels was similar in both groups one hour after premedication (Sublingual group=97% vs Intranasal group=100%).Conclusion:The clinical effects of intranasal and sublingual dexmedetomidine were similar. Level of sedation by sublingual route was less than intranasal route, because a significant proportion of the drug was ingested by children. It may be preferred for premedication in preschool children by intranasal route or at higher doses by sublingual route.

Keywords

• premedication
• children
• dexmedetomidine
• sublingual
• nasal