<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Abstract

Purpose: To compare the efficacy of intranasal dexmedetomidine and dexmedetomidineketamine premedication in preschool children undergoing tonsillectomy. Patients and Methods: We enrolled 66 children with American Society of Anesthesiologists physical status I or II, aged 3-7 years undergoing tonsillectomy. Patients were randomly allocated to receive intranasal premedication with either dexmedetomidine 2 μg kg −1 (Group D) or dexmedetomidine 2 μg kg −1 and ketamine 2 mg kg −1 (Group DK). The primary outcome was the sedation level assessed by the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) 30 min after intervention. The minimal clinically relevant difference in the MOAA/S score was 0.5. Secondary outcomes included sedation onset time, parental separation anxiety, acceptance of mask induction, emergence time, emergence delirium, postoperative pain intensity, length of stay in the post-anesthesia care unit (PACU), and adverse effects. Results: At 30 min after premedication, the MOAA/S score was lower in Group DK than in Group D patients (median: 1.0, interquartile range [IQR]: 1.0-2.0 vs median: 3.0, IQR: 2.0-3.0; P<0.001), with a median difference of 1.0 (95% confidence interval [CI]: 1.0-2.0, P<0.001). Patients in Group DK showed considerably faster onset of sedation (15 min, 95% CI: 14.2-15.8 min) than Group D (24 min, 95% CI: 23.2-24.8 min), with a median difference of 8.0 min (95% CI: 7.0-9.0 min, P<0.001). Both parental separation and facemask acceptance scores were lower in Group DK than in Group D patients (P=0.012 and P=0.001, respectively). There was no significant difference in emergence time, incidence of emergence delirium, postoperative pain scores, and length of stay in the PACU between the two groups. Conclusion: Intranasal premedication with a combination of dexmedetomidine and ketamine produced better sedation for pediatric tonsillectomy than dexmedetomidine alone.

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

“…A rising trend was observed in the onset time concerning age in our study. This onset time was similar to that of Sun’s study (9.6 min) in children between 1 month and 36 months ( 39 ) but shorter than those of other studies on intranasal dexmedetomidine combinations with intranasal/oral ketamine (15–17 min) in children between 0 months and 7 years old ( 14 , 25 , 26 , 31 ). Compared with propofol, this dexmedetomidine-midazolam regimen is time-consuming and requires appropriate time allotment in a high-patient-volume setting.…”

“…Nevertheless, patients can be easily and unpredictably aroused by sounds or movements, which always cause serious interruptions in the MRI and prolong examinations in a busy setting ( 23 ). The addition of intranasal/oral ketamine can enhance intranasal dexmedetomidine-induced sedation efficacy and shorten sedation onset time ( 25 , 26 ). However, this regimen is associated with a large volume of intranasal administration.…”

The Sedative Effects of Inhaled Nebulized Dexmedetomidine on Children: A Systematic Review and Meta-Analysis

“…However, our analysis found that, when nebulized dexmedetomidine was combined with oral or nebulized ketamine, it achieved better sedation and more frequently facilitated the separation from parents. This is consistent with the conclusion of Qian’s research ( 27 ). Dexmedetomidine produces sedative, analgesic, and anti-sympathetic effects by acting on α2 receptors on locus coeruleus ( 28 ).…”

A Comparison of Intranasal Dexmedetomidine, Esketamine or a Dexmedetomidine-Esketamine Combination for Induction of Anaesthesia in Children: A Randomized Controlled Double-Blind Trial

“…However, if the UMSS score of the child did not reach 2 points for more than 40 min, we recorded a satisfactory sedation time of 40 min. This may be the reason that the time to satisfactory sedation in the DS group was significantly shorter than that in the S group (p 0.001 < 0.05).Bin Qian et al compared intranasal dexmedetomidine (2 μg/kg) and dexmedetomidine combined with ketamine (DEX 2 μg/kg + KET 2 mg/kg) for tonsillectomy in preschool children and found that the median onset time of sedation (median) (15 vs 24 min) was significantly faster in the combination group than in the dexmedetomidine-alone group (Qian et al, 2020). In our study, the time to satisfactory sedation in Group D (median) was 23.5 min, which was similar.…”