Intranasal Sufentanil/Midazolam Versus Ketamine/ Midazolam for Analgesia/Sedation

In: Anesthesia

21 Sep 2009

Analgesia Sedation

An increasing number of children are undergoing day-case surgery. Children from 3 to 5 years of age may experience significant emotional upset as a result of hospitalization, fear of separation from parents, and unfamiliar surroundings. Children in this age group may not be fully aware of the necessity of their surgical procedure. They are fearful of injections and cannot be easily reassured with an explanation. The primary clinical need in the pediatric population is for a well-tolerated, effective, and expedient analgesic agent that is safe to use. The intranasal administration of opioids may be an alternative route to intravenous, subcutaneous, oral transmucosal, oral, or rectal administration in some patients. Intranasal administration of lipophilic opioids has been shown to be an effective method of administration that is devoid of major side effects.

Sufentanil is a potent mu opioid agonist used as a perioperative analgesic. Sufentanil is 5-10 times more potent and 2 times more lipophilic than fentanyl, with rapid absorption from the nasal mucosa. In a recent double-blind, randomized, controlled study evaluating in-tranasally administered fentanyl for postoperative analgesia in pediatric patients, satisfactory analgesia was achieved and adverse effects were within an acceptable range. Intranasal sufentanil (1.5-3.0 |xgAg) facilitates separation of children from parents and can provide postoperative analgesia. Don’t blow your budget on pharmacy items buy prevacid medication now

Midazolam is a benzodiazepine that is widely used as a sedative in conscious sedation or monitored anesthetic care. Rapid uptake and high bioavailability of intranasal midazolam has been demonstrated in healthy volunteers. Both intranasal midazolam and sufentanil provide rapid, safe, and effective sedation in small children before anesthesia. Ketamine is a phencyclidine anesthetic agent that provides analgesic activity at subanesthetic doses. It is an N-methyl-D-aspartate receptor antagonist with opioid-receptor activity. Controlled studies and case reports on ketamine demonstrate efficacy in neuropathic and nociceptive pain. Premedication with intranasal administration of S+ ketamine (1-2 mgAg) and midazolam (0.2 mgAg) provides good conditions for induction of anesthesia in preschool children with adverse effects within an acceptable range.

There has, however, been no direct comparison of the combination of intranasal sufentanil/midazolam and ketamine/midazolam to determine which combination is preferable for sedation and perioperative analgesia in preschool children. The aim of this prospective, randomized, double-blind study is to evaluate the efficacy and safety of preoperative sedation and postoperative pain relief with intranasal sufentanil/midazolam when compared with intranasal ketamine/midazolam in children undergoing dental extractions under general anesthesia. cheap generic levitra

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