A Comparative Evaluation of Nebulized Dexmedetomidine, Nebulized Ketamine, and Their Combination as Premedication for Outpatient Pediatric Dental Surgery

Abstract

A nebulized combination of low-dose ketamine and dexmedetomidine produced more satisfactory sedation and provided a smoother induction of general anesthesia than nebulized ketamine or dexmedetomidine alone, with more rapid recovery and no significant side effects.

Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

“…cannulation or injection, but is still associated with high bioavailability of the administered drug. 9,10,16 McCormick et al 10 compared inhalation of nebulised midazolam with intranasal midazolam administration. They concluded that nebulised midazolam administration causes less discomfort than intranasal administration.…”

“…They concluded that a nebulised combination of low dose ketamine and dexmedetomidine produced more satisfactory sedation and provided a smoother induction of general anaesthesia than nebulised ketamine or dexmedetomidine alone. 9 Surendar and colleagues 19 compared the efficacy and safety of intranasal dexmedetomidine (1.0 and 1.5 mg kg À1 ), midazolam (0.2 mg kg À1 ), and ketamine (5 mg kg À1 ) for sedation in paediatric dental patients. They found that the onset of sedation was significantly more rapid in the midazolam and ketamine groups than in the dexmedetomidine groups.…”

“…However, these haemodynamic changes were not clinically significant and did not require any intervention. Zanaty and Metainy, 9 investigated the combination of reduced doses of dexmedetomidine and ketamine nebulised premedication and concluded that by this combination, we can attenuate the cardio-depressant effects of dexmedetomidine by the cardio-stimulatory effects of ketamine.…”

“…1e8 Inhalation of nebulised drug is an alternative method of administration that is relatively easy to set up, does not require venepuncture, and is associated with high bioavailability of the administered drug. 9,10 The aim of the current study was to investigate the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication when administered by inhalation of a nebulised solution 30 min before general anaesthesia in preschool oncologic children undergoing bone marrow biopsy and aspiration.…”

“…The secondary outcomes were acceptance of the medication, parental separation, tolerance of mask induction, perioperative HR and BP, postoperative FLACC pain scale, the incidence of EA, and adverse events. Based on a previous study, 9 22 patients in each group should be sufficient to detect a difference between means of the sedation score of 1, assuming a standard deviation of 0.5 with a power of 80% and a two-sided type I error of 5%. Ninety patients were recruited and were equally distributed between the three treatment groups to account for random errors and for additional comparisons.…”