Comparative Evaluation of Midazolam and Clonidine as Premedicants in Children Undergoing Elective Orodental Surgeries: A Randomized, Double Blind Trial

Background: Preoperative anxiety is common in children that can have impact on induction, emergence from anesthesia and/ or on the psychological state of the child. Intranasal route offers an advantage of rapid and virtually complete absorption due to high mucosal vascularity. Objective: The present study aimed to compare efficacy of midazolam with clonidine for intranasal premedication in pediatric patients scheduled to undergo elective orodental surgeries. Methods: One hundred and five children of either sex, aged between 3-7 years belonging to American Society of Anesthesiologists ASA) physical status 1 and 2 undergoing elective orodental surgeries were randomly assigned to three study groups. Group 1 n=35) received 0.5 ml of 0.2 mg/kg midazolam, Group 2 n=35) received 0.5 ml 1µ/kg clonidine and Group 3 n=35) received 0.5 ml of normal saline in each nostril 40 minutes before inducing anesthesia. Heart rate, mean arterial blood pressure, SpO2, degree of sedation was measured every 10 minutes till 30 minutes according to the 5- point sedation scale. The reaction to intravenous i.v.) cannulation was noted according to 4-point scale and child’s face mask acceptance was noted according to 5-point scale. After induction of anesthesia, vitals were noted every 10 minutes, intraoperatively. Postoperatively, level of sedation was assessed every 10 minutes for one hour using 3- point scale. Results: The difference in sedation score between group 1 and 2 was insignificant at 10 minutes but highly significant at 20 min, 30 min and 40 minutes with more sedation in clonidine group. Heart rate and blood pressure were lower in clonidine group. Children in group 2 had better reaction to i.v. cannulation and mask acceptance scores compared with group 1. Postoperative sedation was highest in clonidine group and these children had better wake up scores than midazolam. Conclusion: Compared to midazolam, intranasal clonidine provides higher sedation level, better mask acceptance and better response to intravenous cannulation.