Midazolam Case Study

Background: The preoperative period is stressful in the paediatric patients; oral premedications make the experience of anaesthesia and surgery more pleasant and less traumatic.
Aim: To evaluate & compare the effects of midazolam and clonidine as oral premedicant for sedation, ease of parental separation, facemask acceptance at the time of induction of anaesthesia, hemodynamic stability, postoperative recovery and complications. Material and methods: Total fifty children of either gender belonging to ASA grade I and II between 2-8yrs age scheduled for elective surgery under general anaesthesia were randomly and equally devided in two groups, 25 patients in each. Group M received oral midazolam (o.5mg/kg) and group C, oral clonidine (4µg/kg)
Midazolam has rapid onset and relatively short duration of action. A dose of 0.25-0.5 mg/kg of midazolam orally has proven to be efficacious in children with fewer side-effects [3]. We used oral syrup of midazolam (2mg /ml ) according to body weight (0.5mg/kg).
Clonidine, although less popular, has been shown to produce preoperative sedation and anxiolysis, has analgesic properties, provide perioperative hemodynamic stability, and decreases narcotic and volatile anesthetic requirements. However, several studies on clonidine have revealed controversial results about its usefulness with some favouring its use while others discouraging its usefulness. Thus we thought it is worthwhile to evaluate sedation score and parental separation score of oral premedicants midazolam and clonidine at 60 and 90 min after the drug administration. Drug acceptability score, facemask acceptability score, hemodynamic stability and postoperative recovery were also evaluated and
Vital monitoring was done continuously in preoperative period. Level of sedation & ease of parental separation were noted at 60 min. & 90 min. after the test drug administration. The child was shifted in operation theater after 90 min of the drug administration. In the operating room intravenous access was secured and sedation score was noted. Standard intraoperative monitoring was used. Heart rate (HR), respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and oxygen saturation were noted before induction of anaesthesia. Inj. glycopyrolate 4-8µg/kg was given to the child. Quality of anaesthetic induction in terms of acceptance of face mask was graded via four point quality of induction score. The child was induced by inhalational agents (with 33% oxygen in 66 % nitrous oxide and 8% sevoflurane) via face mask ,when adequate depth of general anaesthesia (stage III plane I =fixation of eyeball centrally, attenuation of eyelash reflex and pattern of respiration (deep & slow)) was achieved then appropriate sized classic LMA was pushed along hard palate using index finger in classic sniff position of head and cuff inflated & fixed centrally after checking bilateral air entry equal in both sides of