Abstract

Managing preoperative anxiety is a dominant clinical challenge in pediatric anesthesia, with up to 70% of children exhibiting clinically relevant distress prior to induction. Heightened anxiety before surgery is not simply a temporary emotional issue, but can be directly associated with a negative perioperative experience including resistance to separation from parents, difficult mask acceptance, induction agitation, emergence delirium, and maladaptive behaviors days/weeks postoperatively. Traditionally, oral midazolam has been the predominant anxiolytic of choice selected for managing preoperative anxiety in pediatric patients. However, despite its high utilization, oral midazolam may produce variable onset times, paradoxical reactions, and variable clinical effects that limit the quality and reliability of anxiolysis. The goal for delivering atraumatic anesthesia to pediatric patients must be to improve preoperative coping, reduce behavioral resistance, and support smoother transitions between each stage in the perioperative period. With the recent interest in other forms of non-intravenous premedication options, combining intranasal dexmedetomidine and esketamine exemplifies a multimodal approach to the preoperative sedation strategy that offers synergistic anxiolysis and optimized behavior while minimizing the disadvantages associated with administering oral midazolam.

Author Details

Regina Oliver, BSN, RN - 6 years RN experience; Nancy Westbrook, DNP, MSNA, CRNA, FNP-BC, Col (Ret) USAF

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Intranasal Administration, Perioperative Care, Perioperative Period, Pediatrics, Child Patients, Anxiety in Children, Intranasal Dexmedetomidine-Esketamine, Separation Anxiety

Advisor

Nancy Westbrook

Second Advisor

David Sanford

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-17

Full Text of Presentation

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Additional Files

Abstract.pdf (125 kB)

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