A Comparative Study between Nebulized Ketamine, Nebulized Dexmedetomidine and Topical Lidocaine as Premedications for Flexible Fiberoptic Bronchoscopy in Pediatrics

Abstract

Abstract Background Flexible fiberoptic bronchoscopy remains an invaluable tool in the evaluation and management of infant and pediatric respiratory disease. Anesthetic strategies in pediatric fiberoptic bronchoscopy should aim at minimizing respiratory complications as oxygen desaturation, hypoxemia, cough, bronchospasm and airway trauma. Objective To compare between the efficacy and safety of nebulized ketamine, nebulized dexmedetomidine and topical lidocaine as premedication for flexible fiberoptic bronchoscopy in pediatrics regarding the incidence of moderate to severe cough. Patients and Methods This prospective randomized clinical study was conducted in Ain shams University, Pediatric endoscopy unit on 186 children aged 2 to 8 years and classified according to the American Society of Anesthesiologists (ASA) physical status I or II and scheduled for flexible fiberoptic bronchoscopy (either diagnostic or therapeutic). The included patients were divided into 3 equal groups. Group D (Dexmedetomidine group) received nebulized dexmedetomidine 30 minutes before procedure (2 mic/kg), Group K (Ketamine group) received nebulized ketamine 30 minutes before procedure (2 mg/kg), and Group L (lidocaine group) received topical lidocaine 2% (3 mg/kg). Results Mean heart rate was insignificantly different at baseline among the three groups. Heart rate before induction, 15 minutes after induction and in PACU was significantly lower in group D compared with group K and group L (P < 0.001) and significantly higher in group K compared with group L (P < 0.001). Mean arterial blood pressure at baseline, before induction, 15 minutes after induction, and in PACU were insignificantly different among the three groups. Mean propofol requirements in group L were significantly higher compared with group D, and group K (p < 0.001) but insignificantly different between group D and group K. Conclusion Incidence of moderate to severe cough was less with nebulized dexmedtomidine and nebulized ketamine compared with topical lidocaine. There were no significant differences between nebulized dexmedtomidine and nebulized ketamine with regards to the incidence of moderate to severe cough. There was an insignificant difference between dexmedetomidine and ketamine in the incidence of moderate to severe cough, but it was significantly different between dexmedetomidine and lidocaine, and group ketamine and group lidocaine.