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

Xinlei Lu,Han Lin,Chunli Li,Ling Tang,Haiyan Lan

doi:10.3389/fphar.2021.808930

Abstract

Objective: To compare the efficacy of dexmedetomidine, esketamine or combined intranasal administration on the induction of inhalation anaesthesia in children. Methods: Ninety children aged 1–6 years were randomly allocated into three equal groups to be premedicated with either intranasal dexmedetomidine 2 μg/kg (Group D), esketamine 1 mg/kg (Group S), or dexmedetomidine 1 μg/kg combined with esketamine 0.5 mg/kg (Group DS). The primary endpoint was the Induction Compliance Checklist (ICC) Scale. Secondary outcomes included the sedation success rate; the modified Yale Preoperative Anxiety Scale score; the time of reaching up to two points on the University of Michigan Sedation Scale (UMSS); Parental Separation Anxiety Scale; anaesthesiologist satisfaction with induction based on the visual analogue scale; emergence agitation scale score; and adverse effects. Results: The children in the DS group showed a high degree of cooperation with inhalation anaesthesia induction, and their ICC score was significantly lower than that of the D and S groups (p = 0.001), but there was no difference between the D and S groups. The success rate of sedation was higher in Group DS (90%) than in Group D (70%) and Group S (53.3%) (p = 0.007). Anaesthesiologist satisfaction with induction was significantly higher in Group DS than in Groups D and S (p = 0.001). The incidence of emergence agitation and the Paediatric Anaesthesia Emergence Delirium (PAED) score in the DS group were lower than those in the D and S groups. Conclusions: Preoperative intranasal administration of dexmedetomidine combined with esketamine can significantly improve the cooperation of children with inhalation anaesthesia masks. It is a sedation method that has a high success rate and reduces the incidence and degree of emergence agitation.

Highlights

Most children undergoing elective surgery are afraid of the hospital environment and the operating waiting area
Data are presented as numbers, medians (IQRs) or means ± standard deviations; F, female; D, dexmedetomidine; DS, dexmedetomidine-esketamine; M, male; modified Yale Preoperative Anxiety Scale (m-YPAS), the modified yale preoperative anxiety scale; S, esketamine
The results of this trial showed that children sedated with dexmedetomidine combined with esketamine before surgery had higher cooperation in anesthesia induction, higher success

Summary

Introduction

Most children undergoing elective surgery are afraid of the hospital environment and the operating waiting area. It is estimated that approximately 60–70% of children show significant anxiety before surgery (Kain et al, 1996). High levels of preoperative anxiety may lead to poor inhalational anaesthesia induction in children and even induction difficulties. The use of violence during inhalation anaesthesia induction is not a suitable option. Anaesthesiologists should adopt appropriate strategies to reduce the potential psychological trauma to children induced by inhalation anaesthesia. Preoperative sedation is one of the most commonly used methods to prevent and treat preoperative anxiety in children and improve cooperation with inhalation anaesthesia (Kain et al, 2004; Rosenbaum et al, 2009)

Methods

Results

Conclusion