A comparative evaluation of nebulized dexmedetomidine and nebulized ketamine as a premedication in pediatric surgeries: A randomized controlled trial

Abstract

Background: Preoperative anxiety and parental deprivation remains a challenge to anesthesiologists. Dexmedetomidine (DexM) has sedative and analgesic effects via central action. Ketamine (KET) is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces a state of sedation. Nebulization is harmless, has rapid absorption, and an inexpensive administration route. The aim of this work was to compare the effectiveness of aerosolized DexM and aerosolized KET as a premedication to general anesthesia in pediatric surgeries. Methods: This prospective double-blind randomized controlled research was carried out on 60 cases of both sexes aged (3-10) years with ASA physical status I, II who were undergoing elective surgery. Cases were divided equally into 3 groups; group D (Dexmedetomidine): received aerosolized dexmedetomidine (3mcg/kg), group K (Ketamine): received aerosolized KET (3 mg/kg) and group C (control): received aerosolized normal saline without drug. Results: Ramsay sedation scale after 15 minutes was insignificant different between DexM and KET, and after 30 minutes was significantly better in DexM than KET. There was significant difference between DexM versus KET with better parental separation and mask acceptance in DexM than KET. There was a significant decrease in the HR before induction of anesthesia in DexM versus KET and controls. There was no significant difference in recovery and discharge time in all groups. Incidence of hypersalivation was significant in KET more than DexM and controls, while incidence of other complications was insignificant among all groups. Conclusions: Aerosolized dexmedetomidine can be used with advantage versus aerosolized KET for preoperative sedation in pediatric surgeries.