Comparative Study of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedicant in Children

Arun, Nidhi; Choudhary, Annu; Kumar, Mukesh

doi:10.7759/cureus.26572

Cited by 3 publications

(4 citation statements)

References 33 publications

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“…Contrary to other reports a recent study reported that intranasal dexmedetomidine (1 μg kg −1 ) premedication is clinically less effective in terms of sedation and mask acceptance in children as compared to ketamine (5 mg kg −1 ) 28 . This was most likely due to the lower dose of dexmedetomidine (1 μg kg −1 ) used in the study.…”

Section: Discussioncontrasting

confidence: 76%

“…Contrary to other reports a recent study reported that intranasal dexmedetomidine (1 mg kg À1 ) premedication is clinically less effective in terms of sedation and mask acceptance in children as compared to ketamine (5 mg kg À1 ). 28 This was most likely due to the lower dose of dexmedetomidine (1 mg kg À1 ) used in the study. Various trials have reported that the mean peak plasma concentration of dexmedetomidine to achieve acceptable sedation is 0.54 AE 0.17 ng ml À1 which was achieved 30-45 min after the administration of 2-3 mg kg À1 of intranasal dexmedetomidine.…”

Section: Discussionmentioning

confidence: 97%

“…35 A recent study reported that dexmedetomidine premedication is associated with a significantly lower incidence of EA as compared to intranasal ketamine (1.93 AE 0.58 versus 2.83 AE 0.79, P < 0.0001). 28 Patients under dexmedetomidine sedation can be readily aroused by verbal command/ light…”

Section: Discussionmentioning

confidence: 99%

“…Paediatric neurosurgical patients are especially vulnerable to the stress resulting from emergence agitation during the recovery from general anaesthesia 35 . A recent study reported that dexmedetomidine premedication is associated with a significantly lower incidence of EA as compared to intranasal ketamine (1.93 ± 0.58 versus 2.83 ± 0.79, P < 0.0001) 28 . Patients under dexmedetomidine sedation can be readily aroused by verbal command/ light tap and are also less likely to become disorientated and uncooperative 36 .…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Hebbar K,

Reddy,

Luthra

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied. OBJECTIVE To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery. DESIGN A prospective randomised double-blind trial. SETTING A tertiary teaching hospital. PATIENTS Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery METHODS Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg−1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg−1 (Group K, n = 32) 30 min before surgery. OUTCOMES MEASURED The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (Heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted. RESULTS The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, −0.406; 95% CI, −0.621 to −0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, −0.374; 95% CI, −0.650 to 0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported. CONCLUSION Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 97%