Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial

Abstract

Background: Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia.Methods: Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The primary objective of the study was the level of sedation achieved at 30 min using the Ramsay sedation scale, and the secondary objectives were parental separation anxiety score, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results: Seventy patients were randomly divided into two equal groups and analyzed. The median Ramsay sedation score at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions: Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine.

Comparison of Intravenous Versus Nebulized Dexmedetomidine for Laryngoscopy and Intubation-Induced Sympathoadrenal Stress Response Attenuation

“…This may well apply to the nebulized route, which augments the surface area coverage with a thin layer of the drug (12). We attempted to investigate Neb-Dex and compare its efficacy with IV-Dex for attenuating LI since literature regarding Neb-Dex is primarily restricted to procedural sedation as premedication or helping allay separation anxiety in pediatric age group (13)(14)(15)(16)(17)(18). Nebulization provides advantages including cheaper and easier administration, utilization even in resource-limited settings (not requiring special devices like syringe pumps/intranasal atomization devices, etc.…”

“…These findings may be explained based on the fact that the bioavailability of dexmedetomidine through the nasal and buccal mucosa is 65% and 82%, respectively, making 1 mcg/kg nebulized dose equivalent to 0.5 mcg/kg. The bioavailability of dexmedetomidine by other non-intravenous routes is orogastric (16%) and intramuscular (104%) (14). Dexmedetomidine adverse effects are dose-dependent, prompting us to analyze equivalent doses restricted to 1 mcg/kg.…”

A comparison of the anti-anxiety effects of oral ketamine and fluvoxamine in children with separation anxiety disorder manifesting as school refusal

“…In these studies, ketamine with a 5-6 mg/kg dose was applied before surgeries and diagnostic actions. [ 21 22 23 24 25 ] In New Zealand, Glue et al . [ 16 17 ](2019 and 2019) investigated the anti-anxiety effect of ketamine on treatment-resistant patients suffering from SAD and GAD.…”

“…[ 19 20 ] Several studies have investigated the effect of ketamine on reducing the anxiety of children before surgical and diagnostic operations and showed that the medication is effective in decreasing the anxiety of children and their faster separation from their parents before some surgeries such as hernia surgery and diagnostic actions as imaging and audiometry. [ 21 22 23 24 25 ] The implemented studies have not so far reported any severe side effects of ketamine. Thus, considering its immediate anti-anxiety and anti-depression effects reported in past research, this study aimed to investigate the anti-anxiety effect of ketamine and compared it with fluvoxamine as standard therapy in anxiety disorders.…”