Is the Addition of Dexmedetomidine to a Ketamine–Propofol Combination in Pediatric Cardiac Catheterization Sedation Useful?

Abstract

Pediatric patients undergoing cardiac catheterization usually need deep sedation. In this study, 60 children were randomly allocated to receive sedation with either a ketamine-propofol combination (KP group, n = 30) or a ketamine-propofol-dexmedetomidine combination (KPD group, n = 30). Both groups received 1 mg/kg of ketamine and 1 mg/kg of propofol for induction of sedation, and the KPD group received an additional 1 μg/kg of dexmedetomidine infusion during 5 min for induction of sedation and a maintenance infusion of 0.5 μg/kg/h. In both groups, 0.2 mg/kg of propofol was administered as a bolus to maintain a Ramsey sedation score (RSS) greater than 4 throughout the procedure. None of the patients in either group required intubation. In the KP group, one patient required mask ventilation. The chin-lift maneuver needed to be performed for eight patients in the KP group and one patient in the KPD group (p < 0.05). Adding dexmedetomidine to the ketamine-propofol combination decreased movement during the procedures. The heart rate in the KPD group was significantly lower after induction of sedation and throughout the procedure (p < 0.05). No significant differences in systolic blood pressure, diastolic blood pressure, or respiration rates were found between the two groups (p > 0.05). The mean recovery time was longer in the KP group (5.86 vs 3.13 min; p < 0.05). Adding dexmedetomidine to a ketamine-propofol combination led to a reduced need for airway intervention and to decreased movement during local anesthetic infiltration and throughout the procedure. The recovery time was shorter and hemodynamic stability good in the KPD group.

Low‐dose dexmedetomidine as an adjuvant to propofol infusion for children in MRI: A double‐cohort study

“…In these reports, the recommended loading dose (1 lg/kg infusion over 10 minutes) with or without maintenance (0.4-1.0 lg/kg/h) was combined with a propofol infusion. 17,[22][23][24] Le…”

Decreasing the need for mechanical ventilation after surgery forretinopathy of prematurity: sedoanalgesia vs. general anesthesia

“…It is known that high-dose ketamine leads to increased secretion and emesis, and prolongs the recovery period. Propofol has antiemetic and bronchodilator effects and blunts the hemodynamic response while providing good conditions when combined with ketamine (25).…”

Effects of medetomidine and its active enantiomer dexmedetomidine on N‐demethylation of ketamine in canines determined in vitro using enantioselective capillary electrophoresis

“…The affinity of the S ‐enantiomer to the NMDA receptor is two times higher than that of racemic ketamine and four times higher than that of the R ‐enantiomer . Medetomidine is an α 2 ‐adrenergic receptor agonist used for sedation and anesthetic premedication and, because of its anesthetic‐sparing effect, it is applied as anesthetic adjuvant . Low analgesic and myorelaxation effects have also been observed .…”

“…Racemic ketamine, S ‐ketamine, and dexmedetomidine are also used in humans. The combination of them is not as popular as for animals, but there are examples described in the literature .…”