***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : Relieving preoperative anxiety is an important concern for the pediatric anesthesiologist . Midazolam has become the most frequently used premedication in children . However , new drugs such as the α2 -agonists have emerged as alternatives for premedication in pediatric anesthesia . Methods : One hundred and twenty children scheduled for adenotonsillectomy were enrolled in this prospect i ve , double-blind , r and omized study . The children were divided into two equal groups to receive either intranasal dexmedetomidine 1 μg/kg ( group D ) , or oral midazolam 0.5 mg/kg ( group M ) at approximately 60 and 30 mins , respectively , before induction of anesthesia . Preoperative sedative effects , anxiety level changes , and the ease of child-parent separation were assessed . Also , the recovery profile and postoperative analgesic properties were assessed . Results : Children premedicated with intranasal dexmedetomidine achieved significantly lower sedation levels ( P=0.042 ) , lower anxiety levels ( P=0.036 ) , and easier child-parent separation ( P=0.029 ) than children who received oral midazolam at the time of transferring the patients to the operating room . Postoperatively , the time to achieve an Aldrete score of 10 was similar in both the groups ( P=0.067 ) . Also , the number of children who required fentanyl as rescue analgesia medication was significantly less ( P=0.027 ) in the dexmedetomidine group . Conclusion : Intranasal dexmedetomidine appears to be a better choice for preanesthetic medication than oral midazolam in our study . Dexmedetomidine was associated with lower sedation levels , lower anxiety levels , and easier child-parent separation at the time of transferring patients to the operating room than children who received oral midazolam . Moreover , intranasal dexmedetomidine has better analgesic property than oral midazolam with discharge time from postanesthetic care unit similar to oral midazolam BACKGROUND : Midazolam is the most commonly used premedication in children . It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia . Clonidine , an & agr;2 agonist , has been suggested as an alternative . Dexmedetomidine is a more & agr;2 selective drug with more favorable pharmacokinetic properties than clonidine . We design ed this prospect i ve , r and omized , double-blind , controlled trial to evaluate whether intranasal dexmedetomidine is as effective as oral midazolam for premedication in children . METHODS : Ninety-six children of ASA physical status I or II scheduled for elective minor surgery were r and omly assigned to one of three groups . Group M received midazolam 0.5 mg/kg in acetaminophen syrup and intranasal placebo . Group D0.5 and Group D1 received intranasal dexmedetomidine 0.5 or 1 & mgr;g/kg , respectively , and acetaminophen syrup . Patients ’ sedation status , behavior scores , blood pressure , heart rate , and oxygen saturation were recorded by an observer until induction of anesthesia . Recovery characteristics were also recorded . RESULTS : There were no significant differences in parental separation acceptance , behavior score at induction and wake-up behavior score . When compared with group M , patients in group D0.5 and D1 were significantly more se date d when they were separated from their parents ( P < 0.001 ) . Patients from group D1 were significantly more se date d at induction of anesthesia when compared with group M ( P = 0.016 ) . CONCLUSIONS : Intranasal dexmedetomidine produces more sedation than oral midazolam , but with similar and acceptable cooperation Preoperative anxiety and emergence delirium  in children continue to be common even with midazolam premedication . Midazolam is unpleasant tasting even with a flavored vehicle and as a result , patient acceptance is sometimes poor . As an alternative , we evaluated dexmedetomidine administered intranasally . Dexmedetomidine an alpha-2 adrenergic agonist is tasteless , odorless , and painless when administered by this route . Alpha-2 adrenergic agonists produce sedation , facilitate parental separation , and improve conditions for induction of general anesthesia , while preserving airway reflexes . Institutional review board approval was obtained to study 100 pediatric patients r and omized to intranasal dexmedetomidine ( 2 μg/kg ) or oral midazolam ( 0.5 mg/kg ) administered 30 to 45 minutes before the surgery . Subjects received general anesthesia with oxygen , nitrous oxide , isoflurane , and analgesics ( 0.05–0.1 mg/kg morphine or 0.1 mg/kg methadone ) . Nurses and anesthetists were blinded to the drug administered and evaluated patients for preoperative sedation , conditions for induction of general anesthesia , emergence from anesthesia , and postoperative pain . Responses of 100 patients ( 50 dexmedetomidine and 50 midazolam ) were analyzed . Dexmedetomidine ( P = .003 ) was more effective than midazolam at inducing sleep preoperatively . Dexmedetomidine and midazolam were comparable for conditions at induction ( P > 0.05 ) , emergence from anesthesia ( P > 0.05 ) , or postoperative pain ( P > 0.05 ) . Both drugs were equieffective in these regards . In pediatric patients , dexmedetomidine 2 μg/kg administered intranasally and midazolam 0.5 mg/kg administered orally produced similar conditions during induction and emergence of anesthesia . Intranasal administration of dexmedetomidine is more effective at inducing sleep and in some circumstances offers a useful alternative to oral midazolam in children Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care , and who could not be satisfactorily examined or treated , were administered one of three medications -- ketamine ( Ketalar ) , 3 mg/kg ; midazolam ( Versed ) , 0.4 mg/kg ; or sufentanil ( Sufenta ) , 1.5 or 1.0 micrograms/kg -- intranasally in a r and omized , double-blinded protocol . The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse 's arms . Cardiorespiratory monitors were applied when tolerated , and the child was placed on the operating room table . Each child was injected locally with up to one dental cartridge of 2 % lidocaine with 1:100,000 epinephrine before dental extraction s. A sedation score was recorded using a scale where 1 = hysterical/untreatable , 5 = ideal sedation , and 10 = obtunded and desaturated , requiring airway management assistance . Midazolam administration result ed in acceptable sedation ( mean score : 4 ) with no desaturations below 90 % as measured by pulse oximetry and a mean recovery room observation time of only 3 + /- 2 min ( + /- SD ) . Ketamine also had a mean sedation score of 4 and a short recovery period ( 7 + /- 7 min ) ; however , two children experienced brief desaturations .  Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily se date d children ( mean score 7 ) , with a high incidence of significant oximetry desaturation ( 80 % ) and prolonged recovery room duration ( 58 + /- 40 min ) . Use of 1.0 microgram/kg sufentanil result ed in no desaturations , less sedation ( mean score 4 ) , and a brief recovery time ( 7 + /- 13 min ) . ( ABSTRACT TRUNCATED AT 250 WORDS Summary Twelve children 1–5 y old were r and omly assigned to receive midazolam 0.2 mg·kg−1 either by the intravenous ( IV ) or intranasal ( IN ) routes . After IN administration the rapid onset of absorption was observed ( tmax 12 min ) . After both routes of administration the half-life was similar ( 2.2 h IN and 2.4 h IV ) . After IN administration the apparent plasma clearance and volume of distribution were about twice as high as after IV administration . The results are consistent with an estimated mean bioavailability of 55 % Introduction Providing anesthesia to children undergoing MRI is challenging . Adequate premedication , administered noninvasively , would make the process smoother . In this study , we compare the efficacy of intranasal dexmedetomidine ( DXM ) with the intranasal administration of ketamine for procedural sedation in children undergoing MRI . Methods We studied 150 children , between 1 and 10 years of age , divided r and omly into three groups ( DXM , K , and S ) . For blinding , every child received the intranasal drugs twice ; syringe S1 , 60 min before , and syringe S2 , 30 min before intravenous ( IV ) cannulation . For children in group DXM , S1 contained DXM ( 1 μg/kg ) and S2 was plain saline . Children in group K received saline in S1 and ketamine ( 5 mg/kg ) in S2 whereas children in group S received saline in both S1 and S2 . The child ’s response to drug administration , ease of IV cannulation , the satisfaction of the anesthesiologist and child ’s parents with the premedication , and the total propofol dose required for the satisfactory conduct of the procedure were compared . We also compared the time to awakening and discharge of the child as well as the occurrence of any side effects with these drugs . Results Both DXM and ketamine were equally effective as premedication in these patients . Most of the children accepted the intranasal drugs with minimal discomfort ; 90.4 % of the anesthesiologists in the DXM group and 82.7 % in the ketamine group were satisfied with the conditions for IV cannulation whereas only 21.3 % were satisfied in the saline group . The total dose of propofol used was less in the study groups . Furthermore , children in group DXM and group K had earlier awakening and discharge than those in group S. Conclusion DXM and ketamine were equally effective , by the intranasal route , as premedication in children undergoing MRI BACKGROUND Perioperative use of dexmedetomidine is associated with reduction in postoperative analgesic requirements . This study examined whether dexmedetomidine added to i.v . patient-controlled analgesia ( PCA ) morphine could improve analgesia while reducing opioid-related side-effects . METHODS In this double-blinded , r and omized , controlled study , 100 women undergoing abdominal total hysterectomy were allocated to receive either morphine 1 mg ml(-1 ) alone ( Group M ) or morphine 1 mg ml(-1 ) plus dexmedetomidine 5 microg ml(-1 ) ( Group D ) for postoperative i.v . PCA , which was programmed to deliver 1 ml per dem and with a 5 min lockout interval and no background infusion . Cumulative PCA requirements , pain intensities , cardiovascular and respiratory variables , and PCA-related adverse events were recorded for 24 h after operation . RESULTS Compared with Group M , patients in Group D required 29 % less morphine during the 0 - 24 h postoperative period and reported significantly lower pain levels from the second postoperative hour onwards and throughout the study . Whereas levels of sedation were similar between the groups at each observational time point , decreases in heart rate and mean blood pressure from presurgery baseline at 1 , 2 , and 4 h after operation were significantly greater in Group D ( by a range of 5 - 7 beats min(-1 ) and 10 - 13 % , respectively ) . The 4 - 24 h incidence of nausea was significantly lower in Group D ( 34 % vs 56.3 % , P<0.05 ) . There was no bradycardia , hypotension , oversedation , or respiratory depression . CONCLUSIONS The addition of dexmedetomidine to i.v . PCA morphine result ed in superior analgesia , significant morphine sparing , less morphine-induced nausea , and was devoid of additional sedation and untoward haemodynamic changes Both parental presence during induction of anesthesia and sedative premedication are currently used to treat preoperative anxiety in children . A survey study conducted in 1995 demonstrated that most children are taken into the operating room without the benefit of either of these two interventions . In 2002 we conducted a follow-up survey study . Five thous and question naires were mailed to r and omly selected physician members of the American Society of Anesthesiologists . Mailings were followed by a nonresponse bias assessment . Twenty-seven percent ( n = 1362 ) returned the question naire after 3 mailings . We found that a significantly larger proportion of young children undergoing surgery in the United States were reported to  receive sedative premedication  in 2002 as compared with 1995 ( 50 % vs 30 % , P = 0.001 ) . We also found that in 2002 there was significantly less geographical variability in the use of sedative premedication  as compared with the 1995 survey ( 
    Output:
    
Conclusions Intranasal dexmedetomidine provided more satisfactory sedation at parent separation and reduced the need for rescue analgesics and the incidence of nasal irritation and postoperative nausea and vomiting when compared with other premedication treatments .
Conclusion Par rapport aux autres traitements en prémédication , la dexmédétomidine intranasale a procuré une sédation plus satisfaisante lors de la séparation de l’enfant et du parent et réduit le besoin d’analgésiques de sauvetage , l’incidence d’irritation nasale ainsi que les nausées et vomissements postopératoires