Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

Xu, Shang-Xian; Shan, Xi-Sheng; Gao, Jinmeng; Liu, Hua-Xian; Chen, Weirong; Gao, Shanshan; Ji, Fuhai; Peng, Ke; Wang, Qian

doi:10.1186/s40001-022-00890-x

Cited by 5 publications

(8 citation statements)

References 43 publications

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“…On the one hand, it is used for pre-examination sedation, such as improving the cooperation of children with inhalation anesthesia masks 31 better sedation in children with tonsillectomy 33 . Facilitate pediatric upper gastrointestinal endoscopy 34 and pediatric MRI examination 35 . On the other hand, it has been applied to sedation for other pediatric outpatient procedures, such as: hernia in children, circumcision, debridement, and suture.…”

Section: Discussionmentioning

confidence: 99%

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

Wang¹,

Zeng²,

Zhao³

et al. 2023

International Journal of Surgery

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Background: Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery. Materials and methods: The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg −1 , and when the Modified Observer’s Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg −1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events. Results: A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg −1 (95% CI 1.95–2.01 mg·kg −1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10–24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations. Conclusion: The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg −1 . For children aged 2–6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.

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Section: Discussionmentioning

confidence: 99%

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

Wang¹,

Zeng²,

Zhao³

et al. 2023

International Journal of Surgery

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“…In addition, Xu et al stated that both esketaminepropofol and dexmedetomidine-propofol administration produced the same sedation for pediatric patients undergoing 3 Tesla (T) magnetic resonance imaging (MRI), though esketamine-propofol sedation reduced the need for propofol without increasing side effects (36). Another study in children undergoing gastrointestinal endoscopic procedures also showed that post-procedure nausea and vomiting were less in the Ketofol group than in the Ketadex group; however, there was no difference in endoscopic satisfaction between the 2 groups (24).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Adding Low-dose Ketamine to Dexmedetomidine and Propofol on the Quality of Sedation and Hemodynamic Response in Children During Upper Gastrointestinal Endoscopy: A Double-blind Randomized Clinical Trial

et al. 2023

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Background: As endoscopy is an invasive and painful procedure, it is necessary to use a suitable sedative with a minimum dose, especially in children. Objectives: This study aimed to compare the effect of adding low-dose ketamine to dexmedetomidine and propofol on the quality of sedation and hemodynamic response in children during upper gastrointestinal endoscopy. Methods: This double-blind, randomized clinical trial was conducted on 52 children who were candidates for endoscopy in 2 groups, each consisting of 26 patients. In the first group (Ketadex group), infusion of dexmedetomidine (0.7 - 1 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. In the second group (Ketofol group), infusion of propofol (50 - 100 μg/kg) for 10 minutes and ketamine bolus (0.4 mg/kg) for anesthesia induction was prescribed. Results: The mean blood pressure of children decreased slightly during and after the endoscopic procedure in the Ketadex group than in the Ketofol group (P < 0.05). The recovery time was significantly less in the Ketofol group (41.85 ± 7.03 minutes) than in the Ketadex group (55.12 ± 7.55 minutes; P < 0.001). Conclusions: The addition of the low-dose ketamine to propofol and dexmedetomidine did not result in any significant changes in the level of sedation, the incidence of adverse effects, and the endoscopist’s satisfaction; however, the recovery time was shorter in the propofol-ketamine combination than in the dexmedetomidine-ketamine combination.

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“…From the analysis of 10 studies, 2,[19][20][21][22][23][24][25][26][27] we observed that Propofol, in monotherapy, has been effective for this purpose with bolus from 1 to 2 mg/kg, with an average maintenance of 100 mcg/kg/min. 19,20 Most commonly described adverse effects were desaturation, laryngospasm and hypotension.…”

Section: Sedation For Imaging Examsmentioning

confidence: 99%

“…21,22 Combinations with Ketamine, Fentanyl and Dexmedetomidine were associated, respectively, with increased emesis with 1% incidence, optimized analgesia and bradycardia (Table 3). 19,20,23 Azarfar, 2022 11 Monsereenusorn, 2022 13 Nemeth, 2017 12 Miller, 2014 9,14 Sahyoun, 2021 6 Homma, 2020 10 Homma, 2020 10 Dexmedetomidine Infusion: 0,2-0,7 mcg/kg/h There is still not enough evidence to recommend IM and IN bolus use.…”

Section: Sedation For Imaging Examsmentioning

confidence: 99%

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Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years

Monteiro Laranjeira,

Cardoso Andrade,

Souza Cordeiro

et al. 2024

JPNC

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Introduction: Anatomical, physiological, pharmacokinetic, pharmaco dynamic and behavioral particularities relevant to the pediatric population make its sedation challenging for quick and low-complexity procedures. Robust evidence on this subject is still scarce, and the variety of drugs available, with their multiple routes of administration and dosage schemes, makes it difficult for providers to make a decision. Methods: Through research in four databases, we found 170 articles that addressed pediatric sedation and, after applying the exclusion criteria, we selected 32 articles for analysis. Results: In sedation for invasive or painful procedures, Esketamine in monotherapy was effective, despite the significant incidence of adverse effects. Satisfactory responses were also obtained with associations between Esketamine and Propofol and Fentanyl with Propofol or Midazolam. To perform imaging tests, continuous infusions of Propofol or Dexmedetomidine were sufficient, with associations with Esketamine or opioids associated with a higher incidence of adverse effects. Endoscopic procedures have been successfully performed after administration of continuous infusion of Propofol or Dexmedetomidine, associated with Remifentanil infusion or Fentanyl bolus. Esketamine in monotherapy was also effective. Discussion: The drugs studied have an adverse effect profile compatible with safe pediatric sedation, whether administered by a specialist or not. However, alternative administration routes and dosages still need further studies before being routinely applied. Conclusion: Sedation in pediatrics is still an open field for research in our country.

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Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

Cited by 5 publications

References 43 publications

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures：a prospective cohort study

Comparison of the Effect of Adding Low-dose Ketamine to Dexmedetomidine and Propofol on the Quality of Sedation and Hemodynamic Response in Children During Upper Gastrointestinal Endoscopy: A Double-blind Randomized Clinical Trial

Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years

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