Comparative evaluation of dexmedetomidine as a premedication given intranasally vs orally in children between 1 to 8 years of age undergoing minor surgical procedures

Background Dexmedetomidine has been used as a premedication in children primarily via nasal route. Concerns regarding bioavailability and onset of action has restricted its use via oral route. However, oral route is natural and more pleasurable compared to nasal. We compared dexemedetomidine given as a premedication via nasal and oral routes in children undergoing minor surgical procedures. Methods 54 children of ASA PS I grade, aged 1to 8 years, were randomised to one of the two groups. Group I received 1mcg/kg dexmedetomidine intranasally while group II received 3 mcg/kg dexmedetomidine orally, 45 minutes prior to induction of anaesthesia. Depth of sedation was assessed using modified Observer Assessment of Alertness/Sedation Scale just before premedication and every 10 minutes thereafter, till parental separation. Mask acceptance , baseline, minimum and maximum heart rates, at induction were recorded along with post operative complications. Results Though initial sedation scores dropped rapidly in group I compared to group II, final sedation scores were similar in both the groups. There were no difference in the two groups in terms of mask acceptance and hemodynamic parameters at induction. Both the groups showed blunting of hemodynamic response (<20% increase in heart rate) at induction. Conclusion Oral dexmedetomidine (3 mcg/kg) is as effective a premedication as intranasal dexmedetomidine (1 mcg/kg). Dexmedetomidine premedication, in doses and via routes used in this study, blunts hemodynamic response at induction of anaesthesia.