الفهرس 
Pediatric SedationOnly 14 pages are availabe for public view
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Abstract
Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post- operative anxiety is an important concern for the pediatric anesthesiologist. Anxiety can produce aggressive reactions, increase distress, and may make the control of postoperative pain difficult. Pre-anesthetic medication in children should aim at relieving this anxiety and psychological trauma and also to facilitate the induction of anesthesia without prolonging the recovery
A pre-medicate drug must have an acceptable, non-traumatic route of administration in order not to add extra stress to the child. Many studies have shown that intranasal route is an effective way to administer premedication and sedation to children. It is a relatively easy non-invasive route with high bioavailability and rapid onset of action comparable to that of IV administration because of the rich blood supply of the airway mucosa and bypassing the first pass hepatic metabolism. Also, this route is not painful and does not require trained personnel.
The benzodiazepine (midazolam) a GABA receptor stimulator is the most commonly used sedative drug for premedication in children. Administered intranasal, midazolam is an effective option for conscious sedation
Midazolam has a number of beneficial effects when used as premedication in children: sedation, fast onset, and short duration of action. Despite having a number of beneficial effects, it is far from an ideal pre-medicate having side effects such as restlessness, paradoxical hyperactive reaction, cognitive impairment, amnesia, and respiratory depression.
Dexmedetomidine is a newer alpha 2-agonist with a more selective action on the alpha adrenoceptor with both sedative and analgesic properties and is devoid of respiratory depressant effect. Its bioavailability is (72.6–92.1%) when administered via the nasal mucosa. These properties render it potentially useful for anesthesia premedication.