A prospective randomised double blinded comparative study between nasal atomized dexmedetomidine and midazolam as premedicants in paediatric adenotonsillectomy

Adenotonsillectomy is one of the most common ambulatory surgeries in the pediatric population. Fear and anxiety at parental separation is one of the important challenges to the anesthesiologist in spite of improvements in the drug armamentarium, seen in 40-60% children. The gold standard of premedication is Midazolam, which is effective by all routes, intravenous, intramuscular, oral, submucosal and nasal.1,2 Nasal Midazolam is commercially available, each puff delivering 0.5mg. Nasal route is now being popular because it is non-invasive, easy and has rich blood supply which ensures a faster absorption and faster onset of action. Besides, it bypasses the hepatic metabolism, so bioavailability is improved from 40-60% in oral route to about 82% in nasal route. The search for ideal premedicant continues3 and Dexmedetomidine, alpha-2 agonist, is the new kid in town. It is effective by all routes including nasal.3 But, so far only studies with nasal instillation of Dexmedetomidine, is available, especially in children. Syed et al. in 2019 has used atomized form of Dexmedetomidine in adults for minor orofacial procedures. Hence we decided to compare nasal atomized Dexmedetomidine and Midazolam using atomization devices like LMA MAD NASAL and INSED ATOMISER because atomization helps to break down particle to 30-100microns, hence absorption would be quicker with minimum or no side effects.