Drug Design, Development and Therapy (Aug 2020)
Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial
Abstract
Bin Qian,1 Wenting Zheng,2 Jiawei Shi,2 Zihan Chen,2 Yanhua Guo,2 Yusheng Yao2 1Department of Anesthesiology, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China; 2Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Yanhua Guo Tel +86-591-88217841Email [email protected]: To compare the efficacy of intranasal dexmedetomidine and dexmedetomidine-ketamine premedication in preschool children undergoing tonsillectomy.Patients and Methods: We enrolled 66 children with American Society of Anesthesiologists physical status I or II, aged 3– 7 years undergoing tonsillectomy. Patients were randomly allocated to receive intranasal premedication with either dexmedetomidine 2 μg kg− 1 (Group D) or dexmedetomidine 2 μg kg− 1 and ketamine 2 mg kg− 1 (Group DK). The primary outcome was the sedation level assessed by the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) 30 min after intervention. The minimal clinically relevant difference in the MOAA/S score was 0.5. Secondary outcomes included sedation onset time, parental separation anxiety, acceptance of mask induction, emergence time, emergence delirium, postoperative pain intensity, length of stay in the post-anesthesia care unit (PACU), and adverse effects.Results: At 30 min after premedication, the MOAA/S score was lower in Group DK than in Group D patients (median: 1.0, interquartile range [IQR]: 1.0– 2.0 vs median: 3.0, IQR: 2.0– 3.0; P< 0.001), with a median difference of 1.0 (95% confidence interval [CI]: 1.0– 2.0, P< 0.001). Patients in Group DK showed considerably faster onset of sedation (15 min, 95% CI: 14.2– 15.8 min) than Group D (24 min, 95% CI: 23.2– 24.8 min), with a median difference of 8.0 min (95% CI: 7.0– 9.0 min, P< 0.001). Both parental separation and facemask acceptance scores were lower in Group DK than in Group D patients (P=0.012 and P=0.001, respectively). There was no significant difference in emergence time, incidence of emergence delirium, postoperative pain scores, and length of stay in the PACU between the two groups.Conclusion: Intranasal premedication with a combination of dexmedetomidine and ketamine produced better sedation for pediatric tonsillectomy than dexmedetomidine alone.Keywords: preoperative sedation, mask induction, pediatric anesthesia
