A comparison of intranasal ketamine, intranasal dexmedetomidine, and their combination as premedication in pediatric patients undergoing cardiac catheterization

Abstract

Background Minimizing preoperative anxiety and facilitating parental separation may be of particular importance in pediatric patients undergoing cardiac catheterization. This prospective randomized study was conducted to compare intranasal ketamine, intranasal dexmedetomidine, and their combination as sedative premedications in pediatric patients undergoing cardiac catheterization. Patients and methods Ninety pediatric patients aged between 2 and 4 years scheduled for interventional cardiac catheterization under general anesthesia were included in the study and were randomized to receive intranasal ketamine 5 mg/kg, intranasal dexmedetomidine 2 µg/kg, or a combination of intranasal dexmedetomidine 1 µg/kg plus ketamine 3 mg/kg. The primary outcome of the study was children’s behavior during venous cannulation. The secondary outcomes were onset of sedation, behavior at parental separation, propofol consumption during the procedure, recovery time, incidence of postoperative agitation, and other adverse events. Results The number of patients who had satisfactory venipuncture score was significantly higher in group K (83.3%) and group DK (82.7%) than in group D (55.1%). The onset of sedation was significantly faster in group K (8.37±2.8 min) and group DK (16.7±5.9 min) than in group D (26.8±7.6 min). The number of patients who had satisfactory parental separation was comparable among the studied groups. The incidence of emergence agitation and excessive salivation were significantly higher in group K compared with group D and group DK; meanwhile, the incidence of bradycardia was significantly higher in group D compared with group K and group DK. Conclusion Using a combination of intranasal ketamine and dexmedetomidine was associated with significantly more satisfactory venous cannulation conditions and faster onset of sedation than using intranasal dexmedetomidine alone. The combination was also associated with less adverse events than using either drug alone.