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Comparison of intranasal dexmedetomidine and dexmedetomidine-ketamine for premedication in pediatrics patients: A
Ravi Bhat1, M C B Santhosh1, Venkatesh M Annigeri2
1Department of Anaesthesiology, SDM College of Medical Sciences, Dharwad, Karnataka, India.
Insights
Intranasal dexmedetomidine provides acceptable parental separation in pediatric patients undergoing anesthesia. However, mask acceptance remains a challenge, and combining it with ketamine did not improve premedication success.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Sedation and Anxiolysis
Background:
- Midazolam, a common pediatric premedicant, has limitations including paradoxical reactions and cognitive impairment.
- Dexmedetomidine, an alpha-2 agonist, offers an alternative with potential benefits for pediatric anesthesia.
- Effective premedication aims to reduce anxiety, facilitate parental separation, and ensure smooth anesthesia induction.
Purpose of the Study:
- To compare intranasal dexmedetomidine with a dexmedetomidine-ketamine combination for pediatric premedication.
- To evaluate sedation levels, parental separation, mask acceptance, and postoperative recovery.
- To assess the efficacy of these intranasal agents in children aged 1-6 years.
Main Methods:
- Prospective, randomized, double-blind study involving 54 pediatric patients (ASA I-II, aged 1-6 years).
- Group D received 1 μg/kg dexmedetomidine intranasally; Group DK received 1 μg/kg dexmedetomidine and 2 mg/kg ketamine intranasally.
- Assessment of sedation, separation, heart rate, oxygen saturation, mask acceptance, and agitation by an independent observer.
Main Results:
- Acceptable parental separation was achieved in 90% of patients.
- Sedation was acceptable in 80% of patients, with good mask acceptance in 60%.
- No statistically significant differences were found between the dexmedetomidine and dexmedetomidine-ketamine groups for the assessed parameters. Emergence agitation (EA) was low (2%).
Conclusions:
- Intranasal dexmedetomidine effectively provides acceptable parental separation in pediatric patients.
- Mask acceptance in the operating room setting requires improvement.
- The combination of dexmedetomidine and ketamine did not enhance premedication success, but dexmedetomidine use was linked to reduced emergence agitation.
Background:
Goal of premedication in pediatric anesthesia are relieving pre and postoperative anxiety, good parental separation, and smooth induction of anesthesia. Anxiety can produce aggressive reactions, increased distress, increased postoperative pain and postoperative agitation. The benzodiazepine, midazolam, is the most frequently used premedication in pediatric anesthesia. Midazolam has a number of beneficial effects when used as premedication in children: Sedation, fast onset, and limited duration of action. Though midazolam has a number of beneficial effects, it is far from an ideal premedicant having untoward side effects such as paradoxical reaction, respiratory depression, cognitive impairment, amnesia, and restlessness. Dexmedetomidine is a newer α-2-agonist, which can be used as premedicant.
Aims:
To compare the level of sedation, parental separation, mask acceptance, postoperative recovery of intranasal premedication with dexmedetomidine and dexmedetomidine-ketamine combination in pediatric patients.
Settings And Design:
Prospective randomized double-blind study.
Subjects And Methods:
After written informed consent from the patient's parents or legal guardian, 54 children of American Society of Anesthesiologists physical status I or II, aged between 1 and 6 years, scheduled to undergo elective minor surgery were enrolled. In group D patient received 1 μg/kg dexmedetomidine intranasally and in group DK received 1 μg/kg dexmedetomidine and 2 mg/kg ketamine intranasally. Patients were assessed every 10 min for the level of sedation, parenteral separation, heart rate, and oxygen saturation by an independent observer. Mask acceptance and postoperative agitation were noted using an appropriate scale.
Statistical Analysis Used:
Pearson Chi-square analysis to determine differences between two groups with respect to separation anxiety and acceptance of the anesthesia mask. Percentages used to represent frequencies. The level of significance was set at P< 0.05.
Results:
Acceptable parenteral separation was achieved in 90% of patients 30 min after premedication. Sedation was acceptable in 80% of patients at induction. Good mask acceptance was seen in 60% of patients. The incidence of emergence agitation (EA) was 2%. None of the above parameters was statistically significant between the two groups.
Conclusions:
Dexmedetomidine, as premedicant in children provides acceptable parenteral separation. However, mask acceptance in operation room is poor. Combination of dexmedetomidine and ketamine does not increase the success of premedication. Use of dexmedetomidine is associated with decreased EA.
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