engleski

Pre-emptive Dextromethorphan Compared with Midazolam for Premedication in Children

Background: Dextromethorphan is N-methyl-D-aspartate (NMDA) receptor antagonist having mild analgesic and sedative effects. The aim of this study was to test the hypothesis that dextromethorphan, having sedative effects, can be used for premedication in children in comparison with midazolam. Because of its pre-emptive analgesic properties there may be a decrease in the level of postoperative pain and in the amount of analgesic consumption. Methods: Seventy ASA I and II children scheduled for hernia and hypospadias repair, circumcision or orchydopexy were randomized in two groups: the first group (n=35) received dextromethorphan 0.5 mgkg -1 orally 45 min before the induction of anaesthesia, the second received (n=35) midazolam 0.5 mgkg -1 per os. The anaesthesia procedure was standardized. University of Michigan Sedation Scale ( UMSS) scores were measured before the operation and two hours later, pain was measured with visual analogue scale (VAS) and faces scale, according to patients' age at 2, 6 and 12 hours postoperatively. Postoperative analgesic requirements, total dose of rescue analgesic (Diclofenac supp 1 mgkg -1 ) and dextromethorphan side effects were noted. Results: There were no significant differences between the groups in terms of age, weight, gender, ASA physical status, the type and duration of operations . According to the sedation score, preoperative sedation was less with dextromethorphan, but did not reach statistical significance (P=0.531) while postoperative level of sedation was significantly higher in the midazolam group (P <0.002). Comparing the VAS between the two groups at 2, 6 and 12 hours postoperatively we have found that the difference was insignificant at 2 and 6 hours (P =0.635 and P =0.447) while the VAS scores at 12 hours were significantly lower in the dextrometorphan group (P <0.002), but being 2.1 versus 2.4 probably having no clinical relevance. The number of rescue analgesia showed no significant difference between the two groups (0.11±0.3 in the dextromethorphan group and 0.13±0.5 in the midazolam group ; P =0.451). Conclusions: Dextromethorphan administered in a dose of 0.5 mg/kg per os has less sedative effects than midazolam. Postoperative level of sedation is higher in the midazolam group, what is not useful for one-day surgery. The level of postoperative pain measured by VAS and faces scale and the postoperative analgesia requirements seemed equal between the groups in the early postoperative period so there was no pre-emptive effect of dextromethorphan noted.

pre-emptive; dextromethorphan; midazolam; premedication; children

nije evidentirano