Effect of intranasal dexmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children: a randomized, double‐blind, placebo‐controlled trial. Issue 4 (28th January 2014)

• Record Type: Journal Article
• Authors: Savla, Jyothi R.; Ghai, Babita; Bansal, Dipika; Wig, Jyotsna; Lonnqvist, Per‐Arne
• Is Part Of: Paediatric anaesthesia. Volume 24:Issue 4(2014)
• Page Start: 433
• Page End: 439
• Publication Date: 2014-01-28
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12358
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12358-abs-0001"> <title>Summary</title> <sec id="pan12358-sec-0001" sec-type="section"> <title>Introduction</title> <p>This study was conducted to determine the effect of oral midazolam (OM) or intranasal dexmedetomidine (IND) on the EC<sub>50</sub> of sevoflurane for successful laryngeal mask airway placement in children. We hypothesize that premedication with either agent might reduce the sevoflurane EC<sub>50</sub> for laryngeal mask airway placement in children to a similar extent.</p> </sec> <sec id="pan12358-sec-0002" sec-type="section"> <title>Methods</title> <p>Fifty‐two American Society of Anesthesiologists (ASA) I children (aged 1–6 years) scheduled for general anesthesia with laryngeal mask airway were randomized to one of the three groups: group M received 0.5 mg·kg<sup>−1</sup> OM with honey and intranasal saline, group D received 2 μg·kg<sup>−1</sup> IND along with oral honey, and group P received oral honey and intranasal saline at least 30 min prior to induction of anesthesia. Anesthesia was induced with incremental sevoflurane up to 8% in 100% O<sub>2</sub>. A predetermined target endtidal sevoflurane (ET<sub>sevo</sub>) concentration (2% in the first child of all three groups) was sustained for 10 min before the attempt of laryngeal mask airway insertion by adjusting dial concentration. No intravenous anesthetic or neuromuscular blockade was used. ET<sub>sevo</sub> was increased/decreased (step size 0.2%) using Dixon's and Massey's up and down method in next patient depending upon previous patient's response. Placement of the laryngeal mask airway without movement, coughing, biting, or bucking was considered as successful. EC<sub>50</sub> of sevoflurane was calculated as the average of the crossover midpoints in each group, which was further confirmed by probit analysis.</p> </sec> <sec id="pan12358-sec-0003" sec-type="section"> <title>Results</title> <p>The EC<sub>50</sub> of sevoflurane for laryngeal mask airway placement after OM (1.66 ± 0.31) and IND (1.57 ± 0.14) premedications was significantly lower than the placebo group (2.00 ± 0.17, <italic>P </italic>< 0.0001). The EC<sub>95</sub> (95% CI) derived from probit regression analysis was 2.34% (2.22–2.51%) with OM, 1.88% (1.77–2.04%) with IND, and 2.39% (2.25–2.35%) with placebo group.</p> </sec> <sec id="pan12358-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Oral midazolam and IND premedications significantly reduce the sevoflurane EC<sub>50</sub> for laryngeal mask airway insertion in children by 17% and 21%, respectively.</p> </sec> </abstract>