Inhalational dexmedetomidine compared with oral midazolam in pediatric premedication: Impact on postoperative recovery and emergence delirium - pilot study

Abstract

Introduction/Objective. Preoperative fear and anxiety in children are associated with unfavorable postoperative outcomes. Oral midazolam is commonly used for pediatric premedication, but may not always effectively prevent postoperative agitation and delirium. Inhaled dexmedetomidine, due to its sedative and anxiolytic properties, represents a promising alternative. The aim of this study was to compare inhaled dexmedetomidine and oral midazolam regarding emergence time from anesthesia, postoperative recovery, and the incidence of postoperative delirium in children. Methods. This prospective randomized study included 60 children aged 2-12 years, ASA physical status I-II, undergoing surgical procedures. Participants were divided into two groups: the dexmedetomidine group (group D) received inhaled dexmedetomidine 2 μg/kg, while the midazolam group (group M) received oral midazolam 0.3 mg/kg. We assessed emergence time, recovery, and the incidence of postanesthetic delirium. Results. Emergence time did not differ significantly between the groups (Group D: median 8 min, IQR 7-10; Group M: median 7 min, IQR 5-10; Mann-Whitney U test, p = 0.121). Aldrete score improved similarly in both groups during the first 20 minutes, with no significant differences between the groups at the observed time points (p > 0.05). Delirium occurred in 3.3% of patients in Group D and 6.7% in Group M, without a statistically significant difference (Fisher’s exact test, p = 1). Conclusion. Inhaled dexmedetomidine used as a premedication in children was associated with slower emergence, faster recovery, and a lower incidence of delirium compared with oral midazolam, although differences were not statistically significant.