Paediatric anaesthesiaNov 19, 2013

Comparing nasal dexmedetomidine and midazolam as premedication for children having full dental treatment

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 4, 2026

Abstract

The median onset of sedation was 15 minutes for intranasal midazolam compared to 25 minutes for intranasal dexmedetomidine.

Children receiving intranasal midazolam exhibited a significantly shorter onset of sedation than those receiving dexmedetomidine.
A higher percentage of children receiving dexmedetomidine were more sedated when separated from their parents compared to those receiving midazolam.
Satisfactory compliance with mask application was greater in children receiving dexmedetomidine than in those receiving midazolam.
Postoperative agitation and shivering were significantly less common in children who received dexmedetomidine.
Nasal irritation was observed in 36.1% of children receiving midazolam, while none in the dexmedetomidine group experienced this side effect.
No cases of bradycardia or hypotension were reported in either group during the study.

Simplified

BACKGROUND: This prospective, randomized, double-blind study was designed to evaluate the use of intranasally administered dexmedetomidine vs intranasal midazolam as a premedication in children undergoing complete dental rehabilitation.

METHODS: Seventy-two children of American Society of Anesthesiology classification (ASA) physical status (I & II), aged 3-6 years, were randomly assigned to one of two equal groups. Group M received intranasal midazolam (0.2 mg·kg(-1)), and group D received intranasal dexmedetomidine (1 μg·kg(-1)). The patients' sedation status, mask acceptance, and hemodynamic parameters were recorded by an observer until anesthesia induction. Recovery conditions, postoperative pain, and postoperative agitation were also recorded.

RESULTS: The median onset of sedation was significantly shorter in group M 15 (10-25) min than in group D 25 (20-40) min (P = 0.001). Compared with the children in group M, those in group D were significantly more sedated when they were separated from their parents (77.8% vs 44.4%, respectively) (P = 0.002). Satisfactory compliance with mask application was 58.3% in group M vs 80.6% in group D (P = 0.035). The incidences of postoperative agitation and shivering were significantly lower in Group D compared with group M. Thirteen children (36.1%) in group M, showed signs of nasal irritation with teary eyes, and none of these signs was seen in the children in group D (P = 0.000). There were no incidences of bradycardia, hypotension, in either of the groups during study observation.

CONCLUSION: Intranasal dexmedetomidine (1 μg·kg(-1)) is an effective and safe alternative for premedication in children; it resulted in superior sedation in comparison to 0.2 mg·kg(-1) intranasal midazolam. However, it has relatively prolonged onset of action.

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Comparing nasal dexmedetomidine and midazolam as premedication for children having full dental treatment

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