Dexmedetomidine in combination with ketamine for pediatric procedural sedation or premedication: A meta-analysis

Li, Hong-pei; Liu, Kun-peng; Yao, Lan

doi:10.1016/j.ajem.2021.08.073

Cited by 13 publications

(24 citation statements)

References 40 publications

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“…Li et al. found that ketadex resulted in better sedation outcomes than ketamine alone [ 22 ]. Similarly, Hu et al.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that no matter whether ketadex or ketofol can provide more stable hemodynamics than a single agent. A meta-analysis found that, in comparison with either ketamine or dexmedetomidine, ketadex sedation provided more stable heart rate and blood pressure [ 22 ]. Another meta-analysis also found that ketofol was associated with less incidence of cardiovascular adverse events compared to propofol alone [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

Gao

et al. 2022

Heliyon

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“…Li et al. found that ketadex resulted in better sedation outcomes than ketamine alone [ 22 ]. Similarly, Hu et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

Gao

et al. 2022

Heliyon

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“…5,6 However, because ketamine is a sympathomimetic drug, it is known to increase the incidence of hypersalivation, vomiting, agitation and emergence phenomenon when used alone. 7 These side effects of ketamine can be minimised by combining it with other sedatives. 8 Unlike ketamine, dexmedetomidine is known to reduce catecholamines causing hypotension or bradycardia, and its pharmacodynamics for intramuscular (IM) administration is not well understood.…”

Section: Introductionmentioning

confidence: 99%

“…8 Unlike ketamine, dexmedetomidine is known to reduce catecholamines causing hypotension or bradycardia, and its pharmacodynamics for intramuscular (IM) administration is not well understood. 7,8 The ketamine-dexmedetomidine combination for paediatric sedation offers several advantages. These two drugs act complementarily, providing haemodynamic stability while reducing the risk of respiratory depression or bronchial hyperresponsiveness.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of ketamine alone and ketamine‐dexmedetomidine combination for sedation for brain computed tomography in paediatric patients with head injuries: A retrospective study

Yoon,

Park,

Song

et al. 2024

Emerg Medicine Australasia

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ObjectiveTo compare the efficacy and safety of ketamine alone with those of ketamine‐dexmedetomidine combination for sedation during brain CT in paediatric patients with head injuries.MethodsWe retrospectively analysed the data of paediatric patients who underwent sedation for brain CT at the ED. We included patients aged 6 months to 6 years with American Society of Anesthesiologists physical status I or II. The sedative protocol involved the administration of intramuscular (IM) ketamine 3 mg/kg (K), ketamine 2 mg/kg with dexmedetomidine 1.5 μg/kg (KD) or ketamine 1.5 mg/kg with dexmedetomidine 1.5 μg/kg (low‐KD). The primary and secondary outcomes were sedation failure and adverse events, respectively.ResultsWe included 77 patients; among them, 28, 23 and 26 were in the K, KD and low‐KD groups, respectively. In multivariable analysis, the combination groups (KD and low‐KD groups) were significantly associated with a lower possibility of sedation failure compared to the K group (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.56). Moreover, there were no significant differences in adverse events between the groups, and the sedation‐related time variables also did not significantly differ among the three groups.ConclusionsOur findings indicated that a combination of IM ketamine‐dexmedetomidine provides effective sedation for paediatric patients undergoing brain CT without significant adverse events. Further research is needed to investigate the potential benefits of using lower doses of ketamine in combination.

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“…Preoperative sedation can alleviate perioperative anxiety of young children, thus creating a good condition for parental separation and anesthesia induction [ 3 , 4 ]. Currently, various methods can be used to alleviate preoperative anxiety.…”

Section: Introductionmentioning

confidence: 99%

Median effective dose of esketamine for intranasal premedication in children with congenital heart disease

et al. 2023

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Background Esketamine is commonly used as a premedication for its sedation effect. However, the proper dosage for intranasal use in children with congenital heart disease (CHD) has not been determined. This study aimed to estimate the median effective dose (ED50) of esketamine for intranasal premedication in children with CHD. Methods Thirty-four children with CHD who needed premedication in March 2021 were enrolled. Intranasal esketamine was initiated at a dose of 1 mg/kg. Based on the outcome of sedation in the previous patient, the dose for the subsequent patient was either increased or reduced by 0.1 mg/kg, which was adjusted between each child. Successful sedation was defined as a Ramsay Sedation Scale score ≥ 3 and Parental Separation Anxiety Scale score ≤ 2. The required ED50 of esketamine was calculated using the modified sequential method. Non-invasive blood pressure, heart rate, saturation of peripheral oxygen, sedation onset time, and adverse reactions were recorded at 5 min intervals after drug administration. Results The 34 children enrolled had a mean age of 22.5 ± 16.4 (4–54) months and a mean weight of 11.2 ± 3.6 (5.5–20.5) kg; American Society of Anesthesiologists classification I–III. The ED50 of intranasal S(+)-ketamine (esketamine) required for preoperative sedation in pediatric patients with CHD was 0.7 (95% confidence interval: 0.54–0.86) mg/kg, and the mean sedation onset time was 16.39 ± 7.24 min. No serious adverse events, such as respiratory distress, nausea, and vomiting were observed. Conclusions The ED50 of intranasal esketamine was 0.7 mg/kg, which was safe and effective for preoperative sedation in pediatric patients with CHD. Trial registration : The trial was registered in the Chinese Clinical Trial Registry Network (ChiCTR2100044551) on 24/03/2021.

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Dexmedetomidine in combination with ketamine for pediatric procedural sedation or premedication: A meta-analysis

Cited by 13 publications

References 40 publications

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

Efficacy and safety of ketamine alone and ketamine‐dexmedetomidine combination for sedation for brain computed tomography in paediatric patients with head injuries: A retrospective study

Median effective dose of esketamine for intranasal premedication in children with congenital heart disease

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