Online ISSN: 2515-8260

Keywords : premedication

Comparative Study between Intranasal and Oral Midazolam as Premedication in Paediatric Patients

Harshwardhan, Harkomal Kaur, Sanjay Kumar Thakur, Akhilesh Kumar Singh .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 3, Pages 323-329

Background and Objectives: Premedication in paediatric patients undergoing surgery is very much essential to lessen the trauma of separation from parents, to allay apprehension regarding anaesthesia and surgery, to co-operate for venipuncture, mask acceptance and to facilitate induction of general anaesthesia. Midazolam is an ideal premedicant with many desirable properties such as sedation, anxiolysis, minimal cardiovascular and respiratory effects, anterograde amnesia. Hence the present study was undertaken                   to compare between intranasal midazolam and oral midazolam with respect to onset  of sedation, effectiveness and safety. Methodology: The study population consisted of 100 ASA grade I and II patients aged between 2-8 years posted for various elective surgeries at NMCH, Patna. The study population was randomly divided into 2 groups of 50 patients each.
Conclusion: Thus from the above study, we conclude that Onset of sedation was significantly faster with intranasal administration                               compared with oral route. Midazolam administration by either route was equally.  effective and no statistical differences were seen between them. All vital signs were stable throughout the procedure in both groups and no significant differences were seen.



European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 299-306

Postoperative vomiting or retching (POV) can lead to rare but serious medical complications, such as wound dehiscence, bleeding, electrolyte imbalance, dehydration and pulmonary aspiration of gastric contents. Hence the present study was planned to find out the effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under combined spinal epidural block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives.
Methods: 110 female patients who are undergoing total abdominal hysterectomy were included in this observational study. Patients were divided into two groups. 54 patients in group A and 56 patients in group B. Group A received 8mg dexamethasone i.v along with premedication The primary outcome variable was to compare post-operative nausea and vomiting using numerical rating scale (NRS). Secondary outcome variable was visual analogue scale of post- operative pain and overall patient satisfaction.
Results: Age, height, weight, ASA and hemodynamic parameters were compared between the 2 groups but were statistically insignificant. The PONV scores were significantly lower in group receiving dexamethasone during 0.5, 6, 12, 24h postoperatively. The VAS score for post- operative pain was also significantly lower in group receiving dexamethasone. Over all patient satisfaction was much better in those receiving dexamethasone as part of premedication, the total analgesic requirement was also significantly lower. There were no complications.

Comparison of Nebulized Dexmedetomidine Versus Combination Of Nebulized Ketamine And Midazolam For Premedication In Pediatric patients Undergoing Elective Surgery-A Randomized Double Blinded Study

Archana Endigeri, Mahindra Kalashetty,Ranganath Channappagoudar,Ganeshnavar Anilkumar,Subhash Reddy,Kelageri Satish, Vidya B C.,Shweta Lamani,Ganeshnavar Anilkumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 18-29

Background & Aims: We compared  dexmedetomidine with combination of midazolam and ketamine via nebulization for sedation in pediatric patients posted for elective surgery
Methods: Ethical clearance followed by informed consent was taken from guardians. Sixty was our sample size which was divided into two groups of 30 per group. Group A   received dexmedetomidine 2µg/kg & Group B received midazolam 0.1 mg/kg with ketamine 1 mg/kg. The primary objective was mask acceptance scale. Secondary objectives were sedation score, parental separation anxiety scale, post operative emergence agitation, recovery times and side effects. The MS EXCEL was used for data entry & outcomes averaged as Mean with standard deviation (SD) or Median with inter quartile range (IQR). Chi‑square test/ Fisher Exact test, Independent t‑test/Mann‑Whitney U test was used. P < 0.05 was regarded as remarkable.

To Compare The Perioperative Benefits Of Oral Midazolam And Oral Clonidine In Patients Undergoing Major Abdominal Surgeries Under General Anaesthesia

Dipty Agrawal, Jugal Kishor Agarwal, Aijaz Ahmad, Vinay Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1650-1658

Background: One of the challenges for anaesthesiologists is to minimize distress for patients in the operating room (OR) environment and to facilitate a smooth induction of anesthesia.A sedative drug is given before transfer to the OR. The beneficial effects of anxiolytic are sedation, anxiolysis, reduction of postoperative vomiting andpostoperative emergence phenomenon. Clonidine, an α 2-agonist, have been suggested as another option for premedication as effective as midazolam.
Materials and Methods: 50 patients were randomly divided into two groups.To one group Tab. Midazolam 7.5 mg was given while to other group Tab. Clonidine 100 µg was given one hour before induction ofanesthesia.Patients were evaluated and compared for benefits of preoperative oral midazolam and oral clonidine on sedation scores, perioperative hemodynamic parameters and perioperative opioid and analgesic requirement. Independent sample t-test was used and p-value < 0.05 was considered significant.
Results: We found that mean OAA/S sedation score in clonidine group was 11.48 ± 1.12 than in midazolam group13.68 ±1.03withsignificant difference ofp value (p<0.001).There was significant (P < 0.05) attenuation of hemodynamic response to intubation, surgical stress response and extubation with clonidine as compared to midazolam .None of the patients desaturatedin either group. Opioid requirement(72%)was more in midazolam group as compared to clonidine (28%)group. Recovery in clonidine group took slightly longer time 60.00 ± 13.77min as compared to midazolam group 44.40±13.25 min.
Conclusion: Premedication with 100 micrograms of oral clonidine can reasonably be recommended as premedication in ASA I and II patients for all surgeries to provide more sedation, stable hemodynamics intraoperatively, reduction in stress response,less opioid consumption.

Comparison ofpremedication with oral pregabalin and i.v. Dexmedetomidine on hemodynamic changes in patients undergoing laproscopic surgery

Ashok Mittal, Vivek Tyagi , Pramod Chand3, Mahesh Verma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2144-2152

Background:The major problems during laparoscopic surgery are related to the
cardiopulmonary adverse effects of pneumoperitoneum, systemic carbon dioxide absorption,
and patient positioning. Due to the requirement of steep head-up position, the chances and
severity of unwanted hemodynamic responses such as hypertension and tachycardia are much
higher in laparoscopic cholecystectomy when compared with other laparoscopic
surgeries.Objective: The goal of anesthetic management in laparoscopic surgeries is to
minimize these hemodynamic responses along with adequate depth and pain control with the
target of minimal stress response and early discharge.
Materials & Methods:The present study was conducted in MLB Medical College and
hospital, Jhansi,UP.Participants of eithersex with ASA physical status grade I & II, aged 20
to 50 years and planned for elective laparoscopic cholecystectomy under general
anaesthesiawith tracheal intubationwere included in this study.This study was carried out in
100 participants. All selected participants under study were randomely divided into two
groups depending on the premedication used.Group A patients were given i.v.
dexmedetomidine in a dose of 1ug/kg over a period of 10 minutes, diluted with 100ml normal
saline,20minutes prior to induction of anaesthesia.Group B patients were given oral
pregabalin 75 milligrams with sips of water 1.5 hour before induction. Data was analysed in
SPSS 17.0 using unpaired students t test.
Result:We found that Systolic Blood Pressure and Heart Ratewere decreased after intubation
in both the groups but fall was significantly greater in group A when compared to group B
.There was also significant fall in Mean Arterial Pressure after intubation in group A as
compared to group B.

Intranasal midazolam and dexmedetomidine as premedication on haemodynamic stability: A comparative study

Dr. Shilpa Agarwal, Dr. Neeti Agarwal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 160-166

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.


Dhanshree Kale; Arachna Amol Gautam; Shraddha Naik; Avinash G. Bhosale; P. B. Patil; R. N. Mulla

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4112-4117

A prospective, randomized study was performed after acceptance by the Ethics Committee and informed consent of 60 patients seeking elective surgery at the Krishna Hospital and the Medical Research Centre, Karad. The study objective is to evaluate haemodynamic consistency through attenuation of the pressure reaction during laryngoscopy and endotracheal intubation. Group A obtained pregabalin orally with water sips before induction and Group B served as control group, received multivitamin orally with sips of water 1hr before induction. Both groups were uniform in their distribution of age, weight and gender. They had similar physical status with no coexisting disease. Both groups were managed with same anesthetic protocol. It was concluded that the preoperative sedation before giving premedication in control and pregabalin groups are comparable, whereas pregabalin produced better preoperative sedation after one hour of premedication, as evidenced by higher Ramsay sedation score.