European Journal of Molecular & Clinical Medicine

Background and Objectives: Premedication in paediatric patients undergoing surgery is very much essential to lessen the trauma of separation from parents, to allay apprehension regarding anaesthesia and surgery, to co-operate for venipuncture, mask acceptance and to facilitate induction of general anaesthesia. Midazolam is an ideal premedicant with many desirable properties such as sedation, anxiolysis, minimal cardiovascular and respiratory effects, anterograde amnesia. Hence the present study was undertaken                   to compare between intranasal midazolam and oral midazolam with respect to onset  of sedation, effectiveness and safety. Methodology: The study population consisted of 100 ASA grade I and II patients aged between 2-8 years posted for various elective surgeries at NMCH, Patna. The study population was randomly divided into 2 groups of 50 patients each.
Conclusion: Thus from the above study, we conclude that Onset of sedation was significantly faster with intranasal administration                               compared with oral route. Midazolam administration by either route was equally.  effective and no statistical differences were seen between them. All vital signs were stable throughout the procedure in both groups and no significant differences were seen.

Background: Monitored Anaesthesia Care (MAC) typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs.  Present study was aimed to compare middle ear surgeries under sedation and local anaesthesia with midazolam plus dexmed versus midazolam plus nalbuphine.
Material and Methods: Present study was a prospective, comparative study conducted in patients 18-60 years age, either gender, ASA Grade I /II, posted for middle ear surgery under Sedation & local anaesthesia. In first group MD, patients received intravenous inj. midazolam 1 mg plus inj. dexmedetomidine 1 ugm /kg bolus and 0.5 ugm kg added in 100 ml NS infusion, given at 0.3 to 0.4 ugm/ min. In second group MN, patients received intravenous inj. midazolam 1 mg plus inj nacphin 10 mg slowly.
Results: Patients were randomly divided in two groups of 30 each. In present study, age, gender, BMI, ASA grade, type of surgeries (Tympanoplasty, mastoidectomy, stapedectomy) & duration of surgery was comparable & difference was not statistically significant. Ramsay Sedation Score (RSS) at 30,40 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Visual Analogue Score (VAS) at 20, 30,40, 60 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Patient & Surgeon satisfaction score was better in group MD as compared to group MN, but difference was not statistically significant. Conclusion: Dexmedetomidine with midazolam was better than nalbuphine with midazolam, with respect to sedation, analgesic effect, patient & surgeon satisfaction.

Background: Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU).Data comparing Dexmedetomedine and Fentanyl as an effective sedation in mechanically ventilated patients are lacking.
Methods: In a prospective, bouble blind study, we randomly assigned newly mechanically ventilated patients  to receive  Dexmedetomidine (0.3 to 0.7mcg/kg/hr) or fentanyl (1 to 3mcg/kg/hr) with doses adjusted to achieve target sedation goals set by clinicians according to the Richmond Agitation–Sedation Scale (RASS, on which scores range from −5 [unresponsive] to +4 [combative]). Midazolam 0.002 mg/ Kg bolus was administered as rescue sedation if the target sedation score could not be achieved within the infusion range. Primary end points were to assess the total dose of the sedative drugs, time required to achieve target sedation as well as total dose of rescue sedation administered.
Results:  62 patients were included in the study, of which 31 received Dexmedetomidine, and 31 received fentanyl infusion. It was observed that there was a significant difference among the two groups with reference to the time required to achieve target Richmond Agitation Sedation score (RASS) of -1.The mean time to achieve target RASS of -1 in Dexmedetomidine group was 2.97 ± 1.278 hours whereas in Fentanyl group  6.29 ± 3.388 hours  (p<.001  vhs) . The mean rate of infusion required to achieve target RASS of -1 in Dexmedetomidine group was 0.5 ± 0.1 mcg/kg/min and in Fentanyl group 2.7 ± 0.8266 mcg/kg/hr. The mean dose of Midazolam as rescue sedation was higher in Fentanyl group (2.29 ± 1.657) as compared to Dexmedetomidine (0.39 ± 1.202) mg (P < 0.01).
Conclusion:  Dexmedetomidine group achieved adequate sedation in lesser time and in doses within the prescribed clinical range as compared to fentanyl group, in mechanically ventilated patients. Further, the 24 hour midazolam requirement was higher in fentanyl group.

Background & Aims: We compared  dexmedetomidine with combination of midazolam and ketamine via nebulization for sedation in pediatric patients posted for elective surgery
Methods: Ethical clearance followed by informed consent was taken from guardians. Sixty was our sample size which was divided into two groups of 30 per group. Group A   received dexmedetomidine 2µg/kg & Group B received midazolam 0.1 mg/kg with ketamine 1 mg/kg. The primary objective was mask acceptance scale. Secondary objectives were sedation score, parental separation anxiety scale, post operative emergence agitation, recovery times and side effects. The MS EXCEL was used for data entry & outcomes averaged as Mean with standard deviation (SD) or Median with inter quartile range (IQR). Chi‑square test/ Fisher Exact test, Independent t‑test/Mann‑Whitney U test was used. P < 0.05 was regarded as remarkable.

Background: One of the challenges for anaesthesiologists is to minimize distress for patients in the operating room (OR) environment and to facilitate a smooth induction of anesthesia.A sedative drug is given before transfer to the OR. The beneficial effects of anxiolytic are sedation, anxiolysis, reduction of postoperative vomiting andpostoperative emergence phenomenon. Clonidine, an α 2-agonist, have been suggested as another option for premedication as effective as midazolam.
Materials and Methods: 50 patients were randomly divided into two groups.To one group Tab. Midazolam 7.5 mg was given while to other group Tab. Clonidine 100 µg was given one hour before induction ofanesthesia.Patients were evaluated and compared for benefits of preoperative oral midazolam and oral clonidine on sedation scores, perioperative hemodynamic parameters and perioperative opioid and analgesic requirement. Independent sample t-test was used and p-value < 0.05 was considered significant.
Results: We found that mean OAA/S sedation score in clonidine group was 11.48 ± 1.12 than in midazolam group13.68 ±1.03withsignificant difference ofp value (p<0.001).There was significant (P < 0.05) attenuation of hemodynamic response to intubation, surgical stress response and extubation with clonidine as compared to midazolam .None of the patients desaturatedin either group. Opioid requirement(72%)was more in midazolam group as compared to clonidine (28%)group. Recovery in clonidine group took slightly longer time 60.00 ± 13.77min as compared to midazolam group 44.40±13.25 min.
Conclusion: Premedication with 100 micrograms of oral clonidine can reasonably be recommended as premedication in ASA I and II patients for all surgeries to provide more sedation, stable hemodynamics intraoperatively, reduction in stress response,less opioid consumption.

Background:This clinical study was undertaken to compare the effects of intrathecal
midazolam and fentanyl as additives to intrathecal bupivacaine 0.5 % for spinal
anaesthesia.
Materials and Methods: This prospective, randomized, comparative study was
conducted on 100 adult patients of ASA physical status 1 & 2 in the age group of 18
years to 60 years, at MAMATA GENERAL HOSPITAL, KHAMMAM. on patients
admitted for elective surgery from the period october 2017 - september 2019. Patients
belonging to Group A received 3 ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.2 ml
(1 mg) of preservative free midazolam + 0.3 ml of normal saline and Group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.5 ml (25 μg) of fentanyl. Patients were
preloaded with intravenous Ringer’s lactate solution 15 ml / kg just before
administering subarachnoid block. Subarachnoid block was administered in L3-L4
intervertebral space with 25G Quincke’s needle. Standard monitoring was carried out
in the form of pulse oximetry, ECG and non-invasive arterial blood pressure
monitoring. Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation
were recorded every 5mins for first 10mins, every 10mins for next half an hour and
then every 15mins intra operatively. The following parameters were observed - onset
and duration of sensory blockade, maximum level of sensory blockade achieved, two
segment regression, onset and duration of motor blockade, duration of effective
analgesia and any side effects associated with these drugs like nausea, vomiting,
pruritis, bradycardia, and hypotension. Computer generated randomization was used
to allocate patients into two groups. Statistical analysis was done using T-test and
fischers exact test. P value of less than 0.05 was considered to be significant
Results: The present study concludes that there were no differences in the onset of
sensory and motor blockade, maximum level of sensory blockade achieved, and time for
two segment regression. 25μg intrathecal fentanyl was found to provide a longer
duration of sensory and motor blockade and prolonged the time for first rescue
analgesia as compared to 1mg intrathecal midazolam. There was no significant
difference between the two groups with respect to the occurrence of side effects.
Conclusion: Hence, we suggest that addition of intrathecal fentanyl is excellent additive
to Bupivacaine for prolongation of duration of anaesthesia without any deleterious
effects.

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Introduction: Adequate pain control remains a major challenge after ambulatory surgery. Midazolam as adjunct to local anaesthetics in caudal epidural analgesia has been found effective with minimal adverse effects.
Objective: The study was carried out to evaluate the analgesic efficacy of caudal bupivacaine and midazolam in children undergoing genitourinary surgeryfor post operative analgesia and to study the side effects and complications of bupivacaine and midazolam.
Subjects and methods: Sixty children, aged2-12 were randomly selected from routine cases of pediatric genitourinary surgery in NSCB Medical college and Hospital, Jabalpur.Group B receive 0.25% bupivacaine 0.5ml/kg [n=30] and group BM receive combination of 0.25% bupivacaine 0.5ml/kg with 50 microgm/kg midazolam[n=30].Throughout the study period heart rate,arterial BP, respiratory rate were monitored. Postoperative pain was assessed by MODIFIED TODDLER PRESCHOOLER POST OPERATIVE PAIN SCALE [TPPPS].Rescue analgesia was given when pain score was 4 or more than 4. Sedation was evaluated by four point sedation score.
Results: Lowest pain score were observed in BM group. The mean duration of postoperative analgesia in group  B was 7.6+1.5hrs and in group BM was 10.43+0.95 hrs’ which was statistically significant[p<0.05]. There was no significant changes in HR,BP and respiratory rate in both groups. The incidence of nausea and vomiting were equal in both groups. No respiratory depression,motor paralysis or urinary retention in both groups during the period of study.
Conclusion- Caudal administration of bupivacaine , midazolam mixture prolongs postoperative analgesia compare to bupivacaine alone without causing any adverse effects and complications.