Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials

Dwivedi, Priyanka; Patel, Tejas; Bajpai, Vijeta; Singh, Yashpal; Tripathi, Alka; Kishore, Suerkha

doi:10.1007/s12630-022-02305-1

Cited by 17 publications

(10 citation statements)

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“…However, considering the younger age in our study, we opted to administer midazolam intranasally rather than orally because coughing and irritation may result in uncooperativeness. In recent years, more studies revealed that intranasal ketamine could enhance sedation induced by intranasal dexmedetomidine in young children [19,20]. Moreover, there were no adverse events in the trials.…”

Section: Discussionmentioning

confidence: 92%

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate: A double blinded prospective randomized trial

Wang,

Ma,

Yang

et al. 2023

Preprint

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Objectives This study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate. Materials and Methods Infants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time and so on. Results 105 infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). Conclusion Intranasal administration of dexmedetomidine combined with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. Clinical Relevance: Intranasal administration of dexmedetomidine combined with midazolam can be used for sedation in infants with cleft lip and palate imaging procedure and provide a faster onset time. Clinical Trial Registration site: https://www.chictr.org.cn. Clinical Trial Registration number: ChiCTR2100049122.

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Section: Discussionmentioning

confidence: 92%

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate: A double blinded prospective randomized trial

Wang,

Ma,

Yang

et al. 2023

Preprint

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“…Previous researchers have used doses of intranasal ketamine in the range of 3-9 mg kg À1 and intranasal dexmedetomidine 1-3 mg kg À1 . 15,16 Therefore, we used ketamine at 6 mg kg À1 and dexmedetomidine at 2.5 mg kg À1 intranasally and assessed clinical efficacy after 30 min.…”

Section: Discussionmentioning

confidence: 99%

“…A review of the literature revealed a lack of conclusive evidence regarding equity-sedative dosages for intranasal dexmedetomidine and ketamine. Previous researchers have used doses of intranasal ketamine in the range of 3–9 mg kg −1 and intranasal dexmedetomidine 1–3 μg kg −1 15,16 . Therefore, we used ketamine at 6 mg kg −1 and dexmedetomidine at 2.5 μg kg −1 intranasally and assessed clinical efficacy after 30 min.…”

Section: Discussionmentioning

confidence: 99%

“…15 Various studies carried out in children undergoing general surgical and dental procedures have reported conflicting results on the superiority of dexmedetomidine over ketamine premedication when administered as intranasal drops. 16 Moreover, there was a complete absence of literature comparing the efficacy of intranasal atomised dexmedetomidine and ketamine premedication in paediatric neurosurgery. Hence, we conducted this study with the aim of assessing the efficacy of intranasal atomised premedication like ketamine and dexmedetomidine.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Hebbar K,

Reddy,

Luthra

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied. OBJECTIVE To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery. DESIGN A prospective randomised double-blind trial. SETTING A tertiary teaching hospital. PATIENTS Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery METHODS Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg−1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg−1 (Group K, n = 32) 30 min before surgery. OUTCOMES MEASURED The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (Heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted. RESULTS The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, −0.406; 95% CI, −0.621 to −0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, −0.374; 95% CI, −0.650 to 0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported. CONCLUSION Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.

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“…Racemic ketamine and S-ketamine are used as sole premedication [14 ▪ ], but they play a more important role in combination with midazolam [15]. When difficult sedation is anticipated, for example in autistic or very young children, oral midazolam plus oral ketamine may provide better conditions for anaesthesia induction compared with midazolam alone [16 ▪ ].…”

Section: Premedicationmentioning

confidence: 99%

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

Jöhr¹

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion.Recent findingsThe role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α2-agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life.SummaryMidazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.

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Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials

Cited by 17 publications

References 50 publications

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate: A double blinded prospective randomized trial

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate: A double blinded prospective randomized trial

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing

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