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

Abdel‐Ghaffar, Hala Saad; Kamal, Sherif; Sherif, Fatma Adel El; Mohamed, Sahar Abdel-Baky

doi:10.1016/j.bja.2018.03.039

Cited by 54 publications

(73 citation statements)

References 28 publications

(36 reference statements)

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“…These findings are consistent with those in previous reports. 5,19 Emergence delirium in children is still considered a mysterious complication after sevoflurane anesthesia. However, recent findings have demonstrated that dexmedetomidine premedication is effective in reducing emergence delirium and PONV in children.…”

Section: Discussionmentioning

confidence: 99%

“…First, the indicated timing of premedication administration is 30 min before general anesthesia according to the pharmacodynamics data and the literature. 5,19 Although, the latest pharmacokinetics study has shown that the median time needed for intranasal dexmedetomidine to achieve peak concentration is 37 min, and the maximal sedative effect is observed 45 min after dosing. 23 This might lead to awaken some dexmedetomidine-sedated patients during mask induction.…”

Section: Discussionmentioning

confidence: 99%

“…Given its favorable sedative and anxiolytic properties with minimal respiratory depression, there is growing interest in the use of dexmedetomidine, a highly selective alpha-2 adrenergic agonist, for pediatric premedication. 4,5 Several studies have shown that dexmedetomidine premedication provides satisfactory preoperative sedation, alleviates parental separation anxiety, promotes the acceptance of facemask induction, and decreases the incidence of emergence delirium. 6,7 When used as premedication in pediatric patients, intranasal dexmedetomidine has been shown to confer an advantage over oral midazolam (the most commonly used premedication).…”

Section: Introductionmentioning

confidence: 99%

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

Zheng¹,

Shi²,

Chen³

et al. 2020

DDDT

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Purpose: To compare the efficacy of intranasal dexmedetomidine and dexmedetomidineketamine 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zheng¹,

Shi²,

Chen³

et al. 2020

DDDT

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“…Dexmedetomidine (Dex)is an a 2 -adrenoreceptor agonist that has found increasing clinical use-for lung protection, for gentle emergence from anesthesia, as an analgesic, as an adjuvant to local anesthetics during regional anesthesia, and even as a supplemental sedative/anxiolytic (Barends et al, 2017;Nguyen et al, 2017). In the last few years, some studies have shown that nebulized Dex administration may allow minimal systemic effects and rapid drug absorption through the respiratory mucosa (Zanaty & El Metainy, 2015;Abdel-Ghaffar et al, 2018). Although nebulized drug administration may be preferred through pulmonary delivery, there are currently no data describing the nebulized effects of Dex on arterial oxygenation during OLV.…”

Section: Introductionmentioning

confidence: 99%

“…Nebulized respiratory administration may results in maximizing the surface area of absorption, less drug loss and increased clinical effectiveness (Wolfe & Braude, 2010). In pediatric populations, it has been demonstrated nebulized Dex (as a premedicant) significantly improved cannulating conditions such as parental separation, face mask acceptance and IV placement (Abdel-Ghaffar et al, 2018), with no hemodynamic side-effects (Zanaty & El Metainy, 2015;Abdel-Ghaffar et al, 2018). However, these studies were often applied to pediatric populations.…”

mentioning

confidence: 99%

Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial

Gao

et al. 2020

PeerJ

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Background Dexmedetomidine (Dex), a selective a2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 µg/kg (Dex0.5 group), 1 µg/kg (Dex1 group) and 2 µg/kg (Dex2group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 µg/kg, 1 µg/kg and 2 µg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40–50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV15), after 30 and 60 min of OLV (OLV30and OLV60, respectively) and 15 min after reinstitution of TLV (ReTLV). Dynamic compliance was also calculated at TLV15, OLV30, OLV60 and ReTLV. Results Dex decreased the requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate (HR) and mean arterial pressure (MAP) displayed no significant difference among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex administered between 0.5 and 2 µg/kg increased partial pressure of oxygen (PaO2) significantly at OLV30 and OLV60(P = 0.000); however, Dex administered between 1 and 2 µg/kg decreased pulmonary shunt fraction (Qs/Qt) at OLV30 and OLV60(P = 0.000). Compared with the placebo group, there were significant increases with dynamic compliance (Cdyn) after OLV in Dex0.5, Dex1 and Dex2group(P = 0.000). Conclusions. Nebulized dexmedetomidine improved oxygenation not only by decreasing pulmonary shunt but also by improving lung compliance during OLV, which may be effective in managing OLV.

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Dexmedetomidine Preconditioning Protects Cardiomyocytes Against Hypoxia/Reoxygenation-Induced Necroptosis by Inhibiting HMGB1-Mediated Inflammation

Chen

Jiang

Xing

et al. 2019

Cardiovasc Drugs Ther

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

Abstract: NCT02935959.

Cited by 54 publications

References 28 publications

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

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

Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial

Dexmedetomidine Preconditioning Protects Cardiomyocytes Against Hypoxia/Reoxygenation-Induced Necroptosis by Inhibiting HMGB1-Mediated Inflammation

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