Abstract
BackgroundPreoperative anxiety is common in pediatric patients. When dexmedetomidine is used alone for sedation as premedication, children tend to awaken when separated from their parents, and body movements occur during invasive procedures. We tested the hypothesis that the combination of dexmedetomidine and ketamine may be a useful premedication to alleviate preoperative anxiety and improve cooperation during intravenous cannulation in pediatric patients, while producing minimal adverse events.MethodsA total of 135 children, aged 2–5 years and American Society of Anesthesiologists status I–II, scheduled for eye surgery were randomly allocated to receive intranasal dexmedetomidine 2.5 μg/kg (group D), oral ketamine 3 mg/kg and intranasal dexmedetomidine 2 μg/kg (group DK), or oral ketamine 6 mg/kg (group K) 30 min before surgery. Sedation state was evaluated every 10 min after premedication and emotional state was assessed during separation from their parents and peripheral intravenous cannulation. Adverse events were recorded for 24 h postoperatively. The primary endpoint was the rate of successful intravenous cannulation.ResultsThe rate of successful venous cannulation was 47% with dexmedetomidine alone, 68% with ketamine alone, and 80% with combined premedication (P = 0.006). The rate of satisfactory separation from parents was not different among groups. The incidence of adverse events was higher in group K compared with the other two groups (postoperative vomiting, P = 0.0041; respiratory-related complications during the perioperative period, P = 0.0032; and postoperative psychological/psychiatric adverse events, P = 0.0152).ConclusionThe combination of intranasal dexmedetomidine 2 μg/kg and oral ketamine 3 mg/kg produces satisfactory separation from parents and more successful venous cannulation, allowing children to smoothly accept induction of general anesthesia.Trial registrationChinese Clinical Trial Register (Unique identifier: ChiCTR-TRC-14004475, Date of registration: 2 April 2014).
Highlights
Preoperative anxiety is common in pediatric patients
Medication interventions are widely used in clinical practice, and ideal premedication attributes include prompt onset of action, short duration, simple route of administration that is readily accepted by children, minimal side effects, reliable pain relief, and regulation of autonomic responses [2]
The rate of successful venous cannulation was significantly higher in group DK and group K than in group D (P = 0.006), whereas the rate of satisfactory separation did not differ significantly among groups (P = 0.078) (Table 3)
Summary
When dexmedetomidine is used alone for sedation as premedication, children tend to awaken when separated from their parents, and body movements occur during invasive procedures. We tested the hypothesis that the combination of dexmedetomidine and ketamine may be a useful premedication to alleviate preoperative anxiety and improve cooperation during intravenous cannulation in pediatric patients, while producing minimal adverse events. Medication interventions are widely used in clinical practice, and ideal premedication attributes include prompt onset of action, short duration, simple route of administration that is readily accepted by children, minimal side effects, reliable pain relief, and regulation of autonomic responses [2]. Preoperative intranasal instillation of 1–2 μg/kg dexmedetomidine has been reported to produce sedation and ameliorate separation anxiety [3, 4]
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