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

Q2 Medicine Romanian journal of anaesthesia and intensive care Pub Date : 2020-07-01 Epub Date: 2020-08-10 DOI:10.2478/rjaic-2020-0006

Syed T Ali, Veena Asthana, Divya Gupta, Santosh K Singh

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引用次数: 3

Abstract

Introduction: Sedative 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 methods: One 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.

Results: Patients 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).

Conclusion: Melatonin, clonidine, and dexmedetomidine are efficacious for producing preoperative sedation, reducing anxiety, postoperative pain, and emergence delirium.

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口服可乐定、右美托咪定和褪黑素作为小儿脐下手术前用药的比较评价。

前言:在接受手术的儿童中，镇静预用药是主要的药物治疗。本研究比较术前褪黑素、可乐定和右美托咪定在镇静、麻醉诱导、出现谵妄和镇痛方面的作用。材料与方法:拟行脐下手术的儿童105例，年龄3-8岁，男女皆可，ASA I/II级，术前45分钟随机给予可乐定5 mcg/kg (C组)、右美托咪定3 mcg/kg (D组)、褪黑素0.2 mg/kg (M组)。评估术前镇静/焦虑和亲子分离评分(CPSS)。采用相同麻醉技术。术后监测出现性谵妄(Watcha评分)和术后疼痛(客观疼痛量表评分)。结果:患者在人口统计学上具有可比性。3级无镇静评分>。6年10月19日(C组)、2月26日(D组)和7月26日(M组)出现1/2/3级CPSS, 1级CPSS发生率为42.6% (C组)、37.1% (D组)和28.6% (M组)。C组和D组儿童麻醉行为评分(PABS)具有可比性(p = 0.224;95% CI为-0.090 ~ 0.604)，C组和M组(p = 0.144;95% CI为-0.633 ~ 0.061)，而PABS在D组优于M组(p = 0.0007;95% CI -0.890至-0.195)。拔管后即刻Watcha评分分别为33/2/0/0 (C组)、34/1/0/0 (D组)、32/2/1/0 (M组)。30min评分为31/4/0/0 (C组)、33/2/0/0 (D组)、31/4/0/0 (M组);1h评分为28/7/0/0 (C组)、29/6/0/0 (D组)、24/11/0/0 (M组)。两组评分具有可比性(p < 0.05)。目的C组与D组、C组与M组疼痛量表评分比较，差异有统计学意义(p < 0.05)。D组得分低于M组(p = 0.023)。结论:褪黑素、可乐定和右美托咪定对术前镇静、减轻焦虑、术后疼痛和出现性谵妄有较好的作用。

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来源期刊

Romanian journal of anaesthesia and intensive care Medicine-Emergency Medicine

CiteScore

2.30

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0.00%

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期刊介绍： The Romanian Journal of Anaesthesia and Intensive Care is the official journal of the Romanian Society of Anaesthesia and Intensive Care and has been published continuously since 1994. It is intended mainly for anaesthesia and intensive care providers, but it is also aimed at specialists in emergency medical care and in pain research and management. The Journal is indexed in Scopus, Embase, PubMed Central as well as the databases of the Romanian Ministry of Education and Research (CNCSIS) B+ category. The Journal publishes two issues per year, the first one in April and the second one in October, and contains original articles, reviews, case reports, letters to the editor, book reviews and commentaries. The Journal is distributed free of charge to the members of the Romanian Society of Anaesthesia and Intensive Care.