A randomised study of intranasal dexmedetomidine and oral ketamine for premedication in children

Area of Science:

• Pediatric Anesthesiology
• Pharmacology
• Sedation Techniques

Background:

• Premedication in pediatric anesthesia is crucial for managing anxiety and facilitating procedures.
• Intranasal dexmedetomidine and oral ketamine are commonly used agents for pediatric sedation.
• Optimizing the combination of these agents can improve patient and parent experience.

Purpose of the Study:

• To evaluate the efficacy and safety of different combinations of intranasal dexmedetomidine and oral ketamine for pediatric premedication.
• To determine the optimal dosage for achieving adequate sedation and patient cooperation.
• To assess patient acceptance of premedication and procedural tolerance.

Main Methods:

• A randomized study involving 160 children aged 2-6 years.
• Four groups received varying doses of intranasal dexmedetomidine (1 or 2 μg.kg(-1)) and oral ketamine (3 or 5 mg.kg(-1)).
• Sedation levels, emotional state, and acceptance of intravenous cannulation/facemask were assessed using standardized scales.

Main Results:

• Approximately 90% of children accepted premedication with rapid onset of sedation across all groups.
• Higher doses of intranasal dexmedetomidine (2 μg.kg(-1)) combined with oral ketamine (3 or 5 mg.kg(-1)) significantly improved acceptance of intravenous cannulation.
• Group 4 (2 μg.kg(-1) dexmedetomidine + 5 mg.kg(-1) ketamine) showed significantly greater sedation after 30 minutes compared to Group 1.

Conclusions:

• The combination of 2 μg.kg(-1) intranasal dexmedetomidine and 3 mg.kg(-1) oral ketamine represents an optimal premedication strategy for pediatric patients.
• This combination facilitates easier parental separation and improves tolerance to procedures like intravenous cannulation.
• The chosen regimen provides effective sedation without excessive side effects or postoperative complications.