Comparison between Buccal Midazolam versus Intranasal Dexmedetomidine Plus Oral Chloral Hydrate in Reducing Parental Separation Anxiety in Children Undergoing Inguinal Hernia Repair: A randomized Clinical Trial

Abstract

Background: Inguinal hernia repair is the most common surgical treatments among infants. Preoperative anxiety remains challenging concern, affecting around 50% of pediatric patients.Objectives: The purpose of the current research was to assess whether a combination of intranasal dexmedetomidine and oral chloral hydrate induces more effective in sedation compared to buccal midazolam in children undergoing inguinal hernia repair.Patients and methods: This randomized double blinded clinical trial included 80 children aged 2 to 7 years, both sex, American Society of Anesthesiology І and П scheduled for inguinal hernia repair. They were allocated randomly two equal categories; group A: received buccal midazolam at 0.1 mg/ kg mixed with simple syrup, intranasal normal saline drops & oral placebo syrup, and group B: received intranasal dexmedetomidine at 2 μg/kg, oral chloral hydrate at 50 mg /kg, & buccal normal saline. All patients underwent general examination of chest, heart, abdomen and vitals as well as laboratory examinations.Results: There was a significant difference between both groups regarding the Parental separation anxiety scale (PSAS) score (P<0.001), PSAS scores of “1 point” and “2 points” represented 82.5% of the total (33 patients) in the group A, and represented 95 % of the total (38 patients) in the group B. A Most of the children in the two groups “successfully separated from their parents.”Conclusion: In children undergoing inguinal hernia repair, combination of intranasal dexmedetomidine plus oral chloral hydrate provide significant sedation than buccal midazolam, as provided better sedation, easier parental separation and mask acceptance.