Girimurugan Nagarajan

Abstract

Background and Aim: Preanesthetic medication in paediatric patients is well known to be a challenge for anaesthesiologists. Premedication in paediatric population helps to produce a relaxed state with reduced anxiety and increased compliance as well as to ease separation from parent and allowing the patient to tolerate and co-operate with the necessary procedure. Our aim is to do a comparation of dexmedetomidine and midazolam given via intranasal route in children posted for tonsillectomy as premedication. Materials and Methods: This study was conducted in 100 patients of 6 to 12 years posted for tonsillectomy. Patients were randomly allocated into Group M and D. Patient in group M (50) received 0.2mg/kg of midazolam administered intranasally as nasal drop using 1ml insulin syringe and similarly group D (50) received 1µg/kg of dexmedetomidine administered intranasally as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, mask induction score, post-operative agitation score was assessed. Results: Satisfactory sedation was achieved by 86% and 68% of patient in dexmedetomidine and midazolam respectively p (0.03). Satisfactory mask induction was achieved by 84% and 70% of patient in dexmedetomidine and midazolam respectively p (0.09). In terms of post op agitation score there is no difference in both the group p (0.30). During the time between administration of pre op drugs and initiation of anaesthesia, no patient seems to develop hypotension, hypoxia or any other life-threatening complication Conclusion: In our study we concluded that in terms of decreasing anxiety at parental separation both dexmedetomidine and midazolam were found to be equally effective. However, Intranasal dexmedetomidine produced superior sedation scores at separation and induction compared to oral midazolam in paediatric patients.   Keywords: Dexmedetomidine, Midazolam, Intranasal, Paediatrics, Premedication.

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Abstract

In any patient, the skin to subarachnoid space depth varies significantly at completely different levels of the spinal cord and it additionally varies from patient to patient at the same vertebral level as per patient characteristics like age, sex and body mass index. An estimate of the skin to subarachnoid space depth has been shown to minimize the number of unsuccessful tries, consecutive attempts, traumatic or blood-filled lumbar punctures, typically acting as a depth guide for correct spinal needle placement. In this study we estimated the subarachnoid space depth using ultrasound, stocker’s formula and craig’s formula to determine which provided better correlation to the actual subarachnoid space depth. This study is a Prospective observational study done in the Department of Anaesthesiology, Saveetha Medical College and Hospital, Chennai from August 2020 to February 2021. This study concluded that Ultrasound guided measurement of subarachnoid space depth provided better correlation with actual subarachnoid space depth compared to stocker’s and craig’s.   Keywords: Correlation, Craig's formula, Spinal anaesthesia, Stocker's formula, Subarachnoid space depth.

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