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Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial

Bin Qian1, Wenting Zheng2, Jiawei Shi2

  • 1Department of Anesthesiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China.

Drug Design, Development and Therapy
|September 14, 2020
PubMed

Insights

Combining intranasal dexmedetomidine and ketamine provided superior sedation for pediatric tonsillectomy compared to dexmedetomidine alone. This combination also reduced parental separation anxiety and improved mask acceptance in children.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Premedication is crucial for managing anxiety and ensuring smooth induction in pediatric surgical procedures.
  • Intranasal administration offers a non-invasive route for drug delivery in young children.
  • Dexmedetomidine and ketamine are commonly used sedatives with distinct mechanisms of action.

Purpose of the Study:

  • To compare the efficacy of intranasal dexmedetomidine versus a combination of intranasal dexmedetomidine and ketamine for premedication in preschool children undergoing tonsillectomy.
  • To evaluate sedation levels, onset time, parental separation anxiety, mask acceptance, and postoperative outcomes.

Main Methods:

  • A randomized study involving 66 children (aged 3-7 years) undergoing tonsillectomy.
  • Group D received intranasal dexmedetomidine (2 μg/kg).
  • Group DK received intranasal dexmedetomidine (2 μg/kg) plus ketamine (2 mg/kg).
  • Sedation was assessed using the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S).

Main Results:

  • The dexmedetomidine-ketamine group (DK) demonstrated significantly deeper sedation (lower MOAA/S scores) at 30 minutes post-intervention compared to the dexmedetomidine group (D) (P<0.001).
  • Sedation onset was considerably faster in Group DK (15 min) than in Group D (24 min) (P<0.001).
  • Group DK showed reduced parental separation anxiety and improved mask acceptance (P=0.012 and P=0.001, respectively).
  • No significant differences were observed in emergence time, delirium, pain, or PACU stay.

Conclusions:

  • Intranasal dexmedetomidine-ketamine combination provides superior sedation for pediatric tonsillectomy compared to dexmedetomidine alone.
  • This combination is effective in reducing pre-operative anxiety and improving cooperation during mask induction.
  • The findings support the use of dexmedetomidine-ketamine premedication for optimizing the perioperative experience in pediatric tonsillectomy.
Abstract

Keywords:
mask inductionpediatric anesthesiapreoperative sedation

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