Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug‐induced sleep endoscopy in children

Kandil, Ali; Subramanyam, Rajeev; Hossain, Mohamed Monir; Ishman, Stacey L.; Shott, Sally R.; Tewari, Anurag; Mahmoud, Mohamed

doi:10.1111/pan.12931

Cited by 52 publications

(30 citation statements)

References 41 publications

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“…A combination of DEX and ketamine is preferred by many pediatric sleep surgeons due to the lower risk of respiratory depression and upper airway obstruction as compared with other agents . DEX has been shown to replicate non‐rapid eye movement (non‐REM) sleep .…”

Section: Discussionmentioning

confidence: 99%

An updated review of pediatric drug‐induced sleep endoscopy

Wilcox

Bergeron

Reghunathan

et al. 2017

Laryngoscope Investig Oto

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ObjectivesDrug‐induced sleep endoscopy (DISE) involves assessment of the upper airway using a flexible endoscope while patients are in a pharmacologically‐induced sleep‐like state. The aim of this article is to review the current literature regarding the role of DISE in children with obstructive sleep apnea (OSA). The indications, typical anesthetic protocol, comparison to other diagnostic modalities, scoring systems, and outcomes are discussed.MethodsA comprehensive review of literature regarding pediatric DISE up through May 2017 was performed.ResultsDISE provides a thorough evaluation of sites of obstruction during sedation. It is typically indicated for children with persistent OSA after tonsillectomy, those with OSA without tonsillar hypertrophy, children with risk factors predisposing then to multiple sites of obstruction, or when sleep‐state dependent laryngomalacia is suspected. The dexmedotomidine and ketamine protocol, which replicates non‐REM sleep, appears to be safe and is often used for pediatric DISE, although propofol is the most commonly employed agent for DISE in adults. Six different scoring systems (VOTE, SERS, Chan, Bachar, Fishman, Boudewyns) have been used to report pediatric DISE findings, but none is universally accepted.ConclusionsDISE is a safe and useful technique to assess levels of obstruction in children. There is currently no universally‐accepted anesthetic protocol or scoring system for pediatric DISE, but both will be necessary in order to provide a consistent method to report findings, enhance communication among providers and optimize surgical outcomes.Level of EvidenceN/A.

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Section: Discussionmentioning

confidence: 99%

An updated review of pediatric drug‐induced sleep endoscopy

Wilcox

Bergeron

Reghunathan

et al. 2017

Laryngoscope Investig Oto

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show abstract

“…However, this is seen at the expense of inadequate sedation with dexmedetomidine noticed in almost 50% of the patients who required unconscious sedation. In a retrospective review by Kandil et al [7], propofol either alone or along with sevoflurane was associated with greater oxygen desaturation.…”

Section: Discussionmentioning

confidence: 99%

Ideal Drug for Frug Induced Sleep Endoscopy, Protocol Vs Dexmedetomidine- Systematic Review

Mohammed¹

2016

GJO

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Drug induced sleep endoscopy is the most important investigation before surgical planning of obstructive sleep apnea patient. It is performed by artificially inducing sleep in a patient and performing nasal endoscopy in order to identify the site of upper airway obstruction. The most appropriate anesthetic agent would be that which induces sleep without any respiratory inhibition. Propofol has been widely used to perform drug induced sleep endoscopy. However, Dexmedetomidine is a newer drug which has shown to have many advantages making it suitable to drug induced nasal endoscopy. The present study is a systematic review of English literature which compares the utility of Propofol and dexmedetomidine in drug induced sleep endoscopy.

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“…Propofol infusions, coupled with short‐acting narcotics (remifentanil or alfentanil), are commonly used . Dexmedetomidine and ketamine have been described in pediatric drug‐induced sleep endoscopy (DISE), which requires maintenance of spontaneous respiration at varying anesthetic depths . The combination of propofol, dexmedetomidine, and ketamine, with topical local anesthetic, may be particularly useful for maintaining good quality spontaneous respiration.…”

Section: Anesthetic Techniquesmentioning

confidence: 99%

Anesthesia for shared airway surgery in children

Bradley

Lee

Peyton

2020

Pediatric Anesthesia

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Shared airway surgery in children is a complex, high‐risk undertaking that requires continuous communication and cooperation between the anesthetic and surgical teams. Airway abnormalities commonly seen in children, the surgical options, and the anesthetic techniques that can be used to care for this vulnerable population are discussed. Many of these procedures were traditionally carried out using jet ventilation, or intermittent tracheal intubation, but increasingly spontaneously breathing “tubeless” techniques are being used. This review has been written from both the surgical and anesthetic perspective, highlighting the concerns that both specialties have in relation to the maintenance of surgical access and operating conditions, and the need for the provision of anesthesia, oxygenation, and ventilation where the airway is the primary site of operation.

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Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug‐induced sleep endoscopy in children

Cited by 52 publications

References 41 publications

An updated review of pediatric drug‐induced sleep endoscopy

An updated review of pediatric drug‐induced sleep endoscopy

Ideal Drug for Frug Induced Sleep Endoscopy, Protocol Vs Dexmedetomidine- Systematic Review

Anesthesia for shared airway surgery in children

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