Intranasal preoperative sedation with sufentanil in children

Background. Preoperative anxiety in children is a significant issue that negatively affects both their psycho-emotional state and surgical outcomes. Children aged 3–8 years often experience fear of separation from parents, of medical procedures, and drug administration. Traditional sedation methods, such as intravenous administration, are not always convenient in pediatric practice. Nasal administration of medications, particularly sufentanil, a lipophilic opioid with high bioavailability, is a promising alternative requiring clinical evaluation of its efficacy and safety. The aim: to evaluate the effectiveness of intranasal sufentanil at a dose of 1 µg/kg as a preoperative sedative in children undergoing surgery under regional anesthesia, taking into account the level of sedation, anxiety during parental separation, hemodynamic parameters, and behavioral response to painful stimuli. Materials and methods. The study included 56 children aged 3–8 years undergoing elective upper or lower limb surgeries at the Kharkiv Regional Clinical Traumatology Hospital. Patients were randomly assigned to two equal groups: group I — control (normal saline) and group II — study group (intranasal sufentanil 1 µg/kg). Sedation was assessed using the UMSS, anxiety using the PSAS, and pain intensity using the FLACC scale. Statistical analysis was performed using SPSS 19.0 and Microsoft Excel. Results. In the study group, 96.4 % of children achieved a satisfactory level of sedation (UMSS ≥ 1), whereas no child in the control group showed signs of sedation. Anxiety scores on the PSAS were significantly lower in the sufentanil group (89.3 % of children scored 1 and 2) compared to the control group (32.1 %). Hemodynamic parameters remained stable, with no significant adverse effects observed. According to the FLACC scale, 78.6 % of children in the study group had scores ≤ 2 during regional blocks, while only 14.3 % of controls showed similar scores, demonstra­ting a clinically and statistically significant difference (p < 0.001, test). In contrast, most children in the control group (24, or 85.7 %) showed FLACC scores > 2 in response to injections, necessitating additional sedation or analgesia. Conclusions. Intranasal sufentanil at a dose of 1 µg/kg is an effective and safe method of premedication in children, providing satisfactory sedation, reducing anxiety, and allowing for comfortable regional anesthesia without significant effects on hemodynamics.