• Savita Jangra, Vighnesh Ashok, Sameer Sethi, and Jagat Ram.
• From the Department of Anaesthesia and Intensive Care (SJ, VA, SS), and Department of Ophthalmology (JR), Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
• Eur J Anaesthesiol. 2022 Nov 1; 39 (11): 868874868-874.

BackgroundMelatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied.ObjectiveTo study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.DesignA prospective, randomised, double-blind trial.SettingOphthalmic surgery in a university teaching hospital, April 2021 to October 2021.PatientsA total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia.InterventionChildren were randomised to receive pre-operative intranasal dexmedetomidine 2 μg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg -1 (melatonin group), 45 min before surgery.Outcomes MeasuredThe primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain.ResultsThe incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P  = 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit ( P  < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0-4], ( P  = 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.ConclusionAtomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin.Trial RegistrationClinical Trials Registry of India CTRI/2021/03/032388 ( www.ctri.nic.in ).Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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