Anesth Pain Med.  2022 Apr;17(2):173-181. 10.17085/apm.21081.

Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial

• Singariya G
• Malhotra N
• Kamal M
• Jaju R
• Aggarwal S
• Bihani P

• KMID: 2531693
• DOI: http://doi.org/10.17085/apm.21081

Abstract

Background
Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. Methods: Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study’s primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results: The median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions: Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

Keyword

Dexmedetomidine; Ketamine; Nebulization; Pediatrics; Premedication; Sedation

Figure

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  Fig. 1. CONSORT flow diagram. CONSORT: consolidated standards of reporting trials, ASA PS: American Society of Anesthesiologists physical status, URTI: upper respiratory tract infection.

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  Fig. 2. Ramsay sedation scale at baseline and at different time intervals after drug administration between groups. RSS: Ramsay sedation scale. Group D: dexmedetomidine group, Group K: ketamine group.

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  Fig. 3. Hemodynamic parameters (mean heart rate and mean systolic blood pressure) between groups. SBP: systolic blood pressure, HR: heart rate. Group D: dexmedetomidine group, Group K: ketamine group.

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