Dexmedetomidine and ketamine for sedation during spinal anesthesia in children

McVey, Janette D.; Tobias, Joseph D.

doi:10.1016/j.jclinane.2010.03.002

Cited by 49 publications

(34 citation statements)

References 34 publications

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“…This finding supports the notion that inadequate postoperative pain control and sedation may have contributed to the large differences in emergence agitation noted in other studies [3,4,30,31]. The incident of EA was also decrease with the deepen of sedation, which means the incident of EA is correlated to the degree of sedation, this is in accordance with other researches' results [32][33][34]. In our research, the occurrence of emergence agitation decreased when fentanyl was used, although the severity of emergence agitation degraded, there are still 7 children of all patients had emergence agitation, suggesting other reasons or mechanisms are involved in emergence agitation.…”

Section: Discussionsupporting

confidence: 91%

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

Meng

Xia

Luo

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionsupporting

confidence: 91%

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

Meng

Xia

Luo

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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“…In another case series, McVey and Tobias described the successful use of dexmedetomidine and ketamine for procedural sedation during lumbar puncture for spinal anesthesia in 12 pediatric patients. 19 The dosing regimen for the ketamine and dexmedetomidine was similar to that reported by Mester et al…”

Section: Discussionmentioning

confidence: 66%

Dexmedetomidine-Ketamine Sedation in a Child With a Mediastinal Mass

Corridore

Phillips

Rabe

et al. 2012

World J Pediatr Congenit Heart Surg

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Sedation during invasive procedures provides appropriate humanitarian care as well as facilitates the completion of procedures. Although generally safe and effective, adverse effects may occur especially in patients with comorbid diseases. One particularly challenging situation is the child with an anterior mediastinal mass who requires sedation during performance of a biopsy to obtain a tissue diagnosis. When there is evidence of airway compromise, it is generally accepted that the maintenance of spontaneous ventilation is necessary as complete airway obstruction may occur, if positive pressure ventilation is chosen. We present the use of a dexmedetomidine-ketamine combination for procedural sedation in a three-year-old child who presented with a large mediastinal mass and respiratory compromise. Previous reports regarding the use of dexmedetomidine and ketamine for procedural sedation are reviewed and the potential efficacy of this combination is discussed.

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“…On the other point of view, ketamine has powerful analgesic properties and has no respiratory depressant effect. [28]…”

Section: Discussionmentioning

confidence: 99%

“…thought that using ketamine and dexmedetomidine combination increases success rate than dexmedetomidine alone or an equivalent success rate to the high doses of dexmedetomidine, without the risks of adverse cardiovascular effects as bradycardia. [28]…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery

2017

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Background and Aims:Prolonged mechanical ventilation after cardiac surgery is associated with serious complications that increase morbidity and mortality. The present study was designed to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for sedation and analgesia in patients after coronary artery bypass graft (CABG) surgery as regards hemodynamics, total fentanyl dose, time of weaning from mechanical ventilation, time of extubation, and any adverse outcome.Materials and Methods:Seventy post-CABG patients were sedated using ketamine 1 mg/kg IV then 0.25 mg/kg/h infusion combined with either dexmedetomidine or propofol to maintain Ramsay sedation score ≥4 during assisted ventilation. Group KP received ketamine + propofol 1 mg/kg bolus followed by 25–50 μg/kg/min. Group KD received ketamine + dexmedetomidine 1.0 μg/kg over 20 min and then 0.2–0.7 μg/kg/h. Total dose of fentanyl in the first 24 h, time of weaning, time of extubation, mean arterial blood pressure, heart rate, and Intensive Care Unit (ICU) stay time were recorded.Statistics:Sample size of 35 patients was calculated for 90% power, α = 0.05, β = 0.1, and anticipated effect size = 0.40 using sample size software (G*Power version 3.00.10, Germany). Analytic statistics was performed on IBM compatible computer using SPSS version 11.5 (IBM, New York, United States) software package under Windows XP operating system. All results presented in the form of mean ± standard deviation. Data compared using unpaired Student's t-test, P < 0.05 was considered as statistically significant.Results:Group KD showed a significant decrease in mean time of weaning and extubation in group KD in comparison with group KP (374.05 ± 20.25 min vs. 445.23 ± 21.7 min, respectively, P < 0.001) (432.4 ± 19.4 min and 504 ± 28.7 min, respectively, P < 0.0001). Fentanyl consumption showed a significant decrease in group KD in comparison with group KP (41.94 ± 20.43 μg and 152.8 ± 51.2 μg, respectively, with P < 0.0001). There were insignificant difference between both groups as regards hemodynamic stability and length of ICU stay.Conclusion:Using KD combination for sedation, post-CABG surgery provided short duration of mechanical ventilation with less fentanyl dose requirement in comparison with KP with insignificant difference in both groups as regards hemodynamic stability and length of the ICU stay.

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Dexmedetomidine and ketamine for sedation during spinal anesthesia in children

Cited by 49 publications

References 34 publications

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

Dexmedetomidine-Ketamine Sedation in a Child With a Mediastinal Mass

Safety and efficacy of ketamine-dexmedetomidine versus ketamine-propofol combinations for sedation in patients after coronary artery bypass graft surgery

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