Comparative evaluation of intranasal midazolam, dexmedetomidine, ketamine for their sedative effect and to facilitate venous cannulation in pediatric patients: A prospective randomized study

Abusinna, Rasha Gamal; Algharabawy, Wael Sayed; Mowafi, Marwa M.

doi:10.1080/11101849.2022.2033074

Cited by 4 publications

(9 citation statements)

References 22 publications

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“…Intranasal midazolam at a dosage range of 0.2 mg/kg-0.5 mg/kg and intranasal ketamine at a dosage range of 2 mg/kg-10 mg/kg was given in children undergoing various types of surgery or procedure including cardiac surgeries, cancer surgeries, urologic surgeries, ear nose throat surgeries, corrective surgeries, dental treatment, bone marrow biopsy, endotracheal intubation, echocardiography and other elective surgeries. All studies in present analysis described the primary outcomes “number of patients with satisfactory sedation level, number of patients with satisfactory separation from parents, or number of patients with satisfactory induction or mask acceptance” [ 13 – 15 , 18 – 30 ]. The outcome “Onset of sedation” was reported in 4 studies [ 15 , 22 , 23 , 30 ], the outcome “Recovery time” was mentioned in 4 studies [ 18 , 22 , 24 , 28 ], and 5 studies concerned the occurrence of different adverse effects [ 18 , 23 , 26 , 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…All studies in present analysis described the primary outcomes “number of patients with satisfactory sedation level, number of patients with satisfactory separation from parents, or number of patients with satisfactory induction or mask acceptance” [ 13 – 15 , 18 – 30 ]. The outcome “Onset of sedation” was reported in 4 studies [ 15 , 22 , 23 , 30 ], the outcome “Recovery time” was mentioned in 4 studies [ 18 , 22 , 24 , 28 ], and 5 studies concerned the occurrence of different adverse effects [ 18 , 23 , 26 , 28 , 29 ]. The main characteristics of enrolled studies were summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…And consequently 230 items were excluded by full-text reviewing, 12 studies were excluded based on language (4 were written in Spanish, 3 in German, 2 in French, 1 in Italian, 1 in Turkish, and 1 in Korean), 45 were studies not focused on preoperative sedation, 32 studies were concerned with sedatives via other routes of administration, 54 studies were concerned with combined medication, 48 were studies focused on comparison of different dosages and different routes of midazolam, and 39 studies were excluded owing to the inappropriate comparisons. Eventually, 16 studies were chosen in consequent analysis [13][14][15][18][19][20][21][22][23][24][25][26][27][28][29][30]. The details of literatures identification are described in PRISMA flowchart (Fig.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Ketamine group: 30 0.2 mg/kg 5 mg/kg 5-points scale I, IV, V(b) Abusinna RG et al . [ 30 ] 2022 minor elective surgical procedures 2–9 yr, ASA I-II 100 (52/48): 1. Midazolam group: 50 2.…”

Section: Methodsmentioning

confidence: 99%

“…The enrolled studies were published from 1993 to 2022, and 1066 eligible pediatric patients (ages ranged from 24 weeks to 14 years) were involved in total. Intranasal midazolam at a dosage range of 0.2 mg/kg-0.5 mg/ kg and intranasal ketamine at a dosage range of 2 mg/ kg-10 mg/kg was given in children undergoing various types of surgery or procedure including cardiac surgeries, [15,22,23,30], the outcome "Recovery time" was mentioned in 4 studies [18,22,24,28], and 5 studies concerned the occurrence of different adverse effects [18,23,26,28,29]. The main characteristics of enrolled studies were summarized in Table 1.…”

Section: Basic Characteristics Of Enrolled Studiesmentioning

confidence: 99%

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Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

Lang

Wang

et al. 2022

BMC Anesthesiol

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Background Intranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. We conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients. Methods We searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study. Results A total of 16 studies with 1066 patients were enrolled. Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure (SMD = -0.53, with 95% CI [-0.93, -0.13]) and heart rate (HR) (SMD = -1.39, with 95% CI [-2.84, 0.06]). Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level (61.76% vs 40.74%, RR = 1.53, with 95%CI [1.28, 1.83]), more rapid onset of sedation (SMD = -0.59, with 95%CI [-0.90, -0.28]) and more rapid recovery (SMD = -1.06, with 95%CI [-1.83, -0.28]). Current evidences also indicated that the differences of various adverse effects between two groups were not significant. Conclusions Given that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future. Trial registration The protocol of present study was registered with PROSPERO (CRD42022321348).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Literature Search Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Basic Characteristics Of Enrolled Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

Lang

Wang

et al. 2022

BMC Anesthesiol

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A comparative evaluation of intranasal α2-adrenoceptor agonists and intranasal midazolam as premedication in pediatric sedation: A meta-analysis of randomized controlled trials

Zhang

Jiang

et al. 2023

PLoS ONE

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Background Midazolam and α2-adrenoceptor agonists have been widely used off-label as intranasal sedatives for children. The present meta-analysis aimed to evaluate the effects of two interventions in pediatric sedation. Methods PubMed, Embase, and Cochrane Library were searched from inception to April 2022. All randomized controlled trials used intranasal α2-adrenoceptor agonists and midazolam as sedatives in children were enrolled. Parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as outcomes. Results Totally 21 studies with 1,495 patients were included. Only one study reported comparison between midazolam and clonidine met the inclusion criteria, and patients in clonidine group had significantly better mask acceptance compared to midazolam group. Compared with midazolam, using of dexmedetomidine was associated with higher rate of satisfactory parental separation (52.88% vs 75.18%, RR = 0.70, with 95%CI [0.55, 0.90]), anesthesia induction or facemask acceptance (60.92% vs 81.47%, RR = 0.76, 95% CI [0.68, 0.84]) and less incidence of postoperative pain and nasal irritation. Conclusion Compared with midazolam, dexmedetomidine should be considered as the preferred intranasal sedative option for pediatric patients, since it provides more satisfactory sedative level with less incidence of several side effects. But insufficient evidences about effects of intranasal clonidine and overall low and moderate quality evidences evaluated by GRADE system indicate that superiority of intranasal α2-adrenoceptor agonists in pediatric sedation needs to be validated by more studies with high quality and large sample size in future.

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Evaluation of effect of ketamine combined with different sedative and anesthetic drugs in children's short surgery

Zheng,

Fu,

et al. 2023

Preprint

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OBJECTIVE To study anesthesia effect and safety of ketamine combined with dexmedetomidine in short surgery in children. Methods Selected 60 cases of American Society of Anesthesiologists (ASA) I ~ II grades, children with short surgery, aged 2 ~ 7 years, weighing 10 ~ 30kg, and divided into three groups according to random double-blind method, 20 cases in each. All patients received intramuscular injection of ketamine 4–5 mg • kg", atropine 0.01 mg • kg" and midazolam 0.05 mg • kg" before operation. After child enters operating room, he/she will be given oxygen inhalation by mask with oxygen flow rate of 1 ~ 2L/min, and establish a venous pathway. He/she will be given 10% glucose injection 100ml intravenous drip. A: ketamine 1.5 mg • kg "was given intravenously before skin incision, and same amount of normal saline was continuously pumped intravenously; B: ketamine 1.5 mg • kg was given intravenously before skin incision, and dexmedetomidine was pumped intravenously at a load of 0.5µg • kg for 15 min, and then operation was completed at a speed of 0.25 pg • kg • h '; C: Ketamine 1.5 mg/kg was given intravenously before skin incision, and dexmedetomidine was pumped intravenously at a load of 1µg • kg for 15 min, then operation was completed at a speed of 0.5 pg • kg • h '. During operation, 1.5 mg • kg ketamine was given intravenously and intermittently according to degree of anesthesia and surgical stimulation of children. During perioperative period, ECG, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (\(Sp{O_2}\)) of children were continuously monitored, and dose of ketamine added during operation, postoperative waking time and sedation degree score (Ramsay sedation score), as well as preoperative and postoperative blood glucose values were recorded. Results There was no change in \(Sp{O_2}\) during perioperative period; The MAP and HR increased during perioperative period. Compared with increase of MAP and HR, A > B > C, but no difference between A and B, and a difference between A and C; Compared with dosage of additional phenone, dosage of A was much higher than B and C; The Ramsay sedation scores of children after operation showed that A < B < C; The recovery time of children in C was longer than A and B; Compared blood glucose changes before and after operation, A was higher than B and C. Conclusion Dextrmedetomidine pumped with 0.5µg · kg load and 0.25µg · kg maintenance can reduce occurrence of restlessness after ketamine operation without respiratory inhibition, and has no effect on recovery time after operation, and can inhibit stress of hand operation to a certain extent. It can be safely used for anesthesia of children's short operation.

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Comparative evaluation of intranasal midazolam, dexmedetomidine, ketamine for their sedative effect and to facilitate venous cannulation in pediatric patients: A prospective randomized study

Cited by 4 publications

References 22 publications

Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

A comparative evaluation of intranasal α2-adrenoceptor agonists and intranasal midazolam as premedication in pediatric sedation: A meta-analysis of randomized controlled trials

Evaluation of effect of ketamine combined with different sedative and anesthetic drugs in children's short surgery

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