Comparison between intranasal dexmedetomidine and intranasal ketamine as premedication for procedural sedation in children undergoing MRI: a double-blind, randomized, placebo-controlled trial

Gyanesh, Prakhar; Haldar, Rudrashish; Srivastava, Divya; Agrawal, Prashant; Tiwari, Akhilesh Kumar; Singh, Prabhat Kumar

doi:10.1007/s00540-013-1657-x

Cited by 62 publications

(53 citation statements)

References 20 publications

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“…In the study of Gyanesh et al (2014), the use of IN dexmedetomidine (1 µg/kg) as premedication (n=52) reduced propofol dose (P<0.001), duration of awakening (P<0.001) and duration of discharge (P<0.001) compared to the use of IN saline as premedication (n=46) in children aged 1 to 10 years undergoing MRI. All patients were breathing spontaneously and no artificial airway was needed [21].…”

Section: Discussionmentioning

confidence: 99%

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Uusalo

Lehtinen

Löyttyniemi

et al. 2019

Preprint

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Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods: We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45-60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results: The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7-6.0) mg/kg/h in the DEX group and 12.4 (9.8-14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95-97) % and 96 (94-97) %, P < 0.001). Supplemental oxygen was delivered to 33 % of the patients in the THIO group compared to 2 % in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001). Conclusion: Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.

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Section: Discussionmentioning

confidence: 99%

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Uusalo

Lehtinen

Löyttyniemi

et al. 2019

Preprint

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“…Either alone, or when combined with other drugs, ketamine, e.g., by IN deposition (inducing minimal discomfort in children), has led to anesthetists' satisfaction rates of > 90%, vs. 21.3% in the not-ketamine sedated population. The ketamine-treated individuals awoke and were discharged home earlier than the non-treated ones [191].…”

Section: Cardiacmentioning

confidence: 97%

“…Other various sites and procedures of ketamine usage: Ketamine was proven highly useful in both adults and children who require deep sedation in specific sites [187] [191]:…”

Section: Dentistry: Premedication With Nebulized Ketaminementioning

confidence: 99%

Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations

Amit

2018

JPT

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Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economicproblems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite theirhealthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratoryand cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugsfor perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide.Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly useful in theobese. These regimens employ combinations of opioids and non-opioid compounds that reciprocate each analgesicpotencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption andtheir concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine thatsees resurgence among physicians from diverse medical specialties. After summarizing obese patients’ perioperativedrawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness asan analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief exemplifications ofits benefits in non-obese cohorts will be portrayed as well.

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“…Similar results were found in a study con ducted by Gyanesh et al, who reported that children in the dexmedetomidine group had an earlier awakening and discharge than those in the ketamine group, but this differ ence was statistically nonsignificant. 19 Dexmedetomidine is a potent centrallyacting alpha2 agonist, and its action is characterized by easy titrating and a quick recovery from sedation, actually mimicking some aspects of natural sleep, 8,20 as the drug has a short halflife of 1.5-3 h after administering the intravenous doses, and because the main site of action of dexmedeto midine is the locus ceruleus rather than the cerebral cor tex in the CNS. 8,20,21 In the present study, the results of recovery time for ketamine were consistent with the clinical pharmacoki netics and pharmacodynamics of ketamine.…”

Section: Orcid Idsmentioning

confidence: 99%

Comparison of two intravenous sedation techniques for use in pediatric dentistry: A randomized controlled trial

2019

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Background. Psychological methods are the preferred behavior management techniques (BMTs) for children in the dental clinical set. However, sometimes they are not successful. On such occasions, pharmacological methods can be good alternatives. Intravenous sedation is one of these methods, which are very useful in behavior management. It is highly effective when applied appropriately.Objectives. The aim of this study was to evaluate the efficacy of intravenous sedation using dexmedetomidine in comparison with ketamine and atropine in uncooperative children during dental treatment.Material and methods. The study was performed on 40 healthy uncooperative children aged 2-6 years. They were equally and randomly divided into 2 groups: group D -intravenous dexmedetomidine with a loading dose of 1 µg/kg body weight (b.w.), which was followed by 0.2 µg/kg b.w./h via continuous infusion; and group K -intravenous ketamine 2 mg/kg b.w. with atropine 0.01 mg/kg b.w. Vital signs, recovery time and adverse effects were all recorded. Behavior was also evaluated using the Ohio State University Behavioral Rating Scale (OSUBRS).Results. Statistically significant differences appeared in the degree of behavior between the 2 groups (p = 0.03). Group D did better than group K. The mean recovery time was shorter in group D than in group K, but there were no statistically significant differences (p = 0.12). No side effects, episodes of cardiovascular or respiratory instability were reported in either group.Conclusions. The use of intravenous sedation in managing uncooperative children is more effective with dexmedetomidine than with ketamine. The addition of atropine as an adjunct to intravenous ketamine sedation helps in preventing complications. Cite asHammadyeh AR, Altinawi MK, Rostom F. Comparison of two intravenous sedation techniques for use in pediatric dentistry: A randomized controlled trial. Dent Med Probl.

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Comparison between intranasal dexmedetomidine and intranasal ketamine as premedication for procedural sedation in children undergoing MRI: a double-blind, randomized, placebo-controlled trial

Abstract: DXM and ketamine were equally effective, by the intranasal route, as premedication in children undergoing MRI.

Cited by 62 publications

References 20 publications

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations

Comparison of two intravenous sedation techniques for use in pediatric dentistry: A randomized controlled trial

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