Pediatric Anestheisa Medications (PAM)

Introduction

Emergence agitation (EA) is a common side effect of sevoflurane anesthesia in pediatric patients, often causing distress and posing management challenges. Dexmedetomidine, an alpha-2 adrenergic agonist with sedative and analgesic properties, was studied for its potential to reduce EA in children undergoing surgery.

Study Overview

• Scope: A randomized controlled trial including 90 pediatric patients aged 1 to 10 years undergoing superficial abdominal and genital surgery.

• Objective: To assess the effect of dexmedetomidine on reducing EA compared to a placebo.

• Methodology:

  • Patients were randomized into three groups: saline placebo, dexmedetomidine 0.15 µg/kg, and dexmedetomidine 0.30 µg/kg.

  • Anesthesia was maintained with 1% sevoflurane and nitrous oxide with spontaneous ventilation.

  • Recovery characteristics, including time to eye opening (TEO) and incidence of agitation, were recorded.

Key Findings

• Reduction in Agitation:

  • EA incidence was significantly lower in the dexmedetomidine 0.30 µg/kg group (10%) compared to the placebo group (37%).

  • Dexmedetomidine 0.15 µg/kg reduced EA to 17%, but the difference was not statistically significant compared to placebo.

• Recovery Time:

  • Time to eye opening (TEO) was similar across all groups, indicating no prolonged recovery.

• Discharge Times:

  • No significant delay in post-anesthesia care unit (PACU) discharge was observed among groups.

• Safety Profile:

  • Dexmedetomidine was well tolerated with no significant hemodynamic or respiratory adverse effects.

Conclusion

A single intraoperative dose of dexmedetomidine (0.30 µg/kg) effectively reduces EA in pediatric patients following sevoflurane anesthesia without adversely impacting recovery or discharge times.

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For full details, read the publication here.​

Introduction

Propofol is widely used in pediatric anesthesia, but its pharmacokinetics in children differ significantly from adults. This study aimed to develop a pharmacokinetic model specifically for pediatric patients undergoing propofol infusion anesthesia.

Study Overview

• Scope: Conducted in 30 children undergoing minor surgical procedures.

• Objective: To derive pediatric-specific pharmacokinetic parameters for propofol administration using a computer-controlled infusion device.

• Methodology:

  • Blood samples were collected to measure actual propofol plasma concentrations.

  • Initial infusions were based on adult pharmacokinetic models, and adjustments were made based on observed discrepancies.

  • A revised pediatric pharmacokinetic model was then tested prospectively in a second group of children.

Key Findings

• Prediction Accuracy:

  • The adult model overestimated propofol concentrations in children by an average of 18.5%.

  • The revised pediatric model significantly improved prediction accuracy, reducing bias to 0.9%.

• Pharmacokinetic Differences:

  • Children exhibited faster propofol clearance and larger distribution volumes compared to adults.

• Clinical Implications:

  • A pediatric-specific infusion model enhances the accuracy of propofol dosing, ensuring better anesthesia control and recovery times.

Conclusion

The development of pediatric-specific pharmacokinetic parameters allows for safer and more effective administration of propofol in children, reducing the risk of over- or under-dosing.

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For more details, read the full publication here.​

Introduction

Premedication in pediatric anesthesia aims to reduce anxiety and facilitate smooth induction. Midazolam is commonly used, but dexmedetomidine, an alpha-2 agonist with sedative properties, offers an alternative with potentially better pharmacokinetic properties. This study compares the effectiveness of intranasal dexmedetomidine versus oral midazolam.

Study Overview

• Scope: A randomized, double-blind controlled trial involving 96 pediatric patients undergoing minor elective surgeries.

• Objective: To compare sedation effectiveness, behavior at parental separation and induction, and recovery outcomes between intranasal dexmedetomidine and oral midazolam.

• Methodology:

  • Patients were divided into three groups:

    • Group M (midazolam 0.5 mg/kg orally),

    • Group D0.5 (intranasal dexmedetomidine 0.5 µg/kg),

    • Group D1 (intranasal dexmedetomidine 1.0 µg/kg).

  • Sedation and behavior scores were assessed at parental separation, induction, and recovery.

Key Findings

• Sedation Effectiveness:

  • Intranasal dexmedetomidine (1.0 µg/kg) provided significantly greater sedation at separation and induction compared to oral midazolam.

  • Dexmedetomidine 0.5 µg/kg offered intermediate sedation but was not as effective as the higher dose.

• Behavioral Outcomes:

  • Both dexmedetomidine groups showed better parental separation scores than midazolam, with fewer cases of distress.

  • No significant differences in wake-up behavior were observed.

• Hemodynamic Effects:

  • Dexmedetomidine caused a mild decrease in blood pressure and heart rate but remained within acceptable clinical ranges.

• Recovery Characteristics:

  • Time to discharge was comparable across all groups, indicating no prolongation with dexmedetomidine use.

Conclusion

Intranasal dexmedetomidine provides superior sedation compared to oral midazolam, making it a viable premedication alternative for pediatric anesthesia without prolonging recovery.

Learn More

For full details, read the publication here.​