Preoperative anxiety is a major concern for pediatric patients undergoing surgical procedures. This anxiety can significantly impact their experience and increase the risk of complications, including emergence delirium and postoperative nightmares (PNBC). Premedication is vital to reduce anxiety and facilitate smooth anesthesia induction.
## Combating Surgery Anxiety in Preschoolers: A Novel Approach
Researchers have explored various medications for premedication in children, including intranasal dexmedetomidine and esketamine. Dexmedetomidine is known for its anxiolytic properties but may cause bradycardia and hypotension, while esketamine offers rapid onset and offset but can also lead to disorientation and increased blood pressure. This study investigated whether combining these two medications could provide a balanced approach to pediatric premedication.
The Study Design
This prospective, randomized, double-blind, three-arm clinical trial was conducted at Fujian Provincial Hospital in China. Preschool children aged 2-5 years scheduled for tonsillectomy and/or adenoidectomy under sevoflurane anesthesia were included. The study enrolled 108 participants who were randomly assigned to one of three groups:
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Intranasal dexmedetomidine (2 μg/kg)
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Intranasal esketamine (1 mg/kg)
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Combination therapy (dexmedetomidine 1 μg/kg plus esketamine 0.5 mg/kg)
Patients received standard monitoring, anesthesia induction, and postoperative care.
Measuring Success
The primary outcome was the incidence of emergence delirium. Researchers also assessed the incidence of PNBC, sedation level,