European Journal of Molecular & Clinical Medicine

Abstract

Background and Aims: Preoperative anxiety and psychological trauma due to separation from parents before shifting to operation theatre are the major challenges in paediatric anaesthesia. Premedication in children aims at relieving anxiety and facilitates a smoother induction of anaesthesia. Melatonin (N-acetyl-5-methoxytryptamine), a naturally occurring sleep inducing hormone, available commercially is used as an effective premedicant without altering haemodynamic parameters. Thus we aimed at comparing the efficacy of two doses of oral melatonin i.e. 0.5mg/kg and 0.75mg/kg as premedication in children undergoing elective surgery under general anaesthesia.
Methods: Sixty patients of either sex of American Society of Anaesthesiologists (ASA) physical status I and II scheduled for elective paediatric surgery were randomly assigned to one of the two groups of 30 patients each in a double blind manner after taking written informed consent from their parents. Group A received oral Melatonin 0.5mg/kg and Group B received oral Melatonin 0.75mg/kg, 45 minutes prior to surgery in the preoperative area in presence of their parents. Patients were assessed on Modified Yale Pre-operative Anxiety scale, Sedation Score, Behaviour score and Mask acceptance score.
Results: The demographic characteristics of the two groups were comparable. Anxiety scores reduced significantly in both groups (P <0.01) and were lower than baseline at the time of introduction of mask; but the reduction in anxiety score was more with 0.75mg/kg of oral melatonin. The sedation score was comparable in both groups. Mean parent child separation scale score was comparable at the baseline between study groups (3.4 vs 3.19: P = 0.19). The scores significantly fell in both groups till 30 minutes after premedication (2.2 vs 1.72; P <0.01). The mask acceptance score was significantly lower in group B as compared to group A (1.77 vs 2.27; P <0.01). No difference was observed between study groups in terms of heart rate, mean arterial pressure, oxygen saturation and respiratory rate at baseline and its mean change during follow up till 30 minutes.
Conclusion: Our study concluded that premedication with oral Melatonin (0.5 mg/kg and 0.75 mg/kg) in children significantly decreases pre-operative anxiety without impairing cognitive and psychomotor functions with 0.75 mg/kg dose being more effective.