Abstract
OBJECTIVE: To compare the clinical effects and safety of remiazolam and esketamine in preoperative sedation in children. METHODS: This study was conducted among 61 children (1-4 years old) undergoing elective bilateral tonsillectomy with or without adenoidectomy under general anesthesia from January 2022 to March 2023. The children were randomized into two groups to receive preoperative sedation with intravenous administration of 0.2 mg/kg remidazolam (R group, 30 cases) or 0.5 mg/kg esketamine (S group, 31 cases). The two groups were compared for PSAS score, vital signs (MAP, SpO(2), and HR), sedation score, mask acceptance score at induction, sedation onset time, postoperative recovery time, MAP and HR after induction, Ramsay sedation score after awakening, doses of propofol and remifentanil during anesthesia, emergence agitation (EA), postoperative adverse effects and negative postoperative behavioral changes (NPOBCs) on the 7th and 14th days after operation. RESULTS: The PSAS score, sedation score, mask acceptance score at induction, MAP and HR after induction, Ramsay sedation score after awakening, propofol dose during anesthesia induction, and the incidence of EA and NPOBCs after operation were all similar between the two groups (P > 0.05). Compared with those in S group, the sedation onset time was slightly longer, the recovery time was shorter, and the doses of propofol and remifentanil for anesthesia maintenance was higher (P < 0.05) in R group. Sedation with remidazolam did not cause significant changes in MAP, SpO(2) or HR (P > 0.05), while administration of esketamine significantly increased MAP and HR (P < 0.05) without obviously affecting SpO(2) (P > 0.05). CONCLUSION: In children aged 1-4 years, compared with 0.5 mg/kg esketamine, intravenous injection of 0.2 mg/kg remidazolam for preoperative sedation has a slightly longer onset time and is associated with a shorter recovery time and more stable hemodynamics, suggesting its good feasibility and safety.