Premedication and induction of anaesthesia in paediatric patients

Dave, Nandini

doi:10.4103/ija.ija_491_19

Cited by 67 publications

(67 citation statements)

References 42 publications

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“…1,2 To alleviate preoperative anxiety and achieve a smooth induction of inhalation anesthesia, a variety of pharmacological and nonpharmacological methods have been proposed as preoperative anxiolytics to minimize the distress of children in the operating room. 3 The ideal preoperative medication should be natural to accept, fast in onset and offset, and reliable in achieving a targeted sedation level without any adverse effects.…”

Section: Introductionmentioning

confidence: 99%

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Zheng¹,

Shi²,

Chen³

et al. 2020

DDDT

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Purpose: To compare the efficacy of intranasal dexmedetomidine and dexmedetomidineketamine premedication in preschool children undergoing tonsillectomy. Patients and Methods: We enrolled 66 children with American Society of Anesthesiologists physical status I or II, aged 3-7 years undergoing tonsillectomy. Patients were randomly allocated to receive intranasal premedication with either dexmedetomidine 2 μg kg −1 (Group D) or dexmedetomidine 2 μg kg −1 and ketamine 2 mg kg −1 (Group DK). The primary outcome was the sedation level assessed by the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) 30 min after intervention. The minimal clinically relevant difference in the MOAA/S score was 0.5. Secondary outcomes included sedation onset time, parental separation anxiety, acceptance of mask induction, emergence time, emergence delirium, postoperative pain intensity, length of stay in the post-anesthesia care unit (PACU), and adverse effects. Results: At 30 min after premedication, the MOAA/S score was lower in Group DK than in Group D patients (median: 1.0, interquartile range [IQR]: 1.0-2.0 vs median: 3.0, IQR: 2.0-3.0; P<0.001), with a median difference of 1.0 (95% confidence interval [CI]: 1.0-2.0, P<0.001). Patients in Group DK showed considerably faster onset of sedation (15 min, 95% CI: 14.2-15.8 min) than Group D (24 min, 95% CI: 23.2-24.8 min), with a median difference of 8.0 min (95% CI: 7.0-9.0 min, P<0.001). Both parental separation and facemask acceptance scores were lower in Group DK than in Group D patients (P=0.012 and P=0.001, respectively). There was no significant difference in emergence time, incidence of emergence delirium, postoperative pain scores, and length of stay in the PACU between the two groups. Conclusion: Intranasal premedication with a combination of dexmedetomidine and ketamine produced better sedation for pediatric tonsillectomy than dexmedetomidine alone.

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Section: Introductionmentioning

confidence: 99%

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Zheng¹,

Shi²,

Chen³

et al. 2020

DDDT

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“…[ 18 ] Use of dexmedetomidine as premedication to decrease postoperative emergence agitation in paediatric age group have been studied by Dave NM. [ 19 ] Use of dexmedetomidine infusion @ 0.5 μg/kg/h provided propofol and opioid-sparing effect in the present study. Similar results were concluded in the studies done by Gupta N et al .…”

Section: Discussionmentioning

confidence: 97%

Total intravenous anaesthesia with tumescent infiltration anaesthesia without definitive airway for early excision and skin grafting in a major burn - A prospective observational study

Salgaonkar¹,

Jain²,

Pawar³

2020

Indian J Anaesth

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Background and Aims: Patients with major burns posted for early tangential excision and skin grafting pose peculiar challenges for anaesthesiologists. The purpose of the study was to assess safety and efficacy of total intravenous anaesthesia (TIVA) with tumescent infiltration anaesthesia (TIA) for these burn procedures. Methods: This observational single-arm study was conducted on 48 cases of a tertiary centre burn unit, requiring early tangential excision and skin grafting between third and fifth days of burn injury. TIVA was administered using a combination of intravenous (iv) infusion of injection dexmedetomidine and iv boluses of fentanyl, ketamine, propofol, midazolam and paracetamol. TIA was administered in burn wounds after aseptic preparation. Spontaneous breathing was maintained with oxygen supplementation. Haemodynamic and respiratory monitoring was done intraoperatively every 15 minutes and for 6 hours postoperatively. Modified Aldrete's score was calculated at 10 minutes after completion of surgery. Statistical analysis was done using statistical package for the social science software (version 16). Descriptive statistics were used for quantitative variables. Results: Baseline mean HR was 106.95 ± 11.17 bpm (beats per minute). HR settled at 73.17 ± 6.97 bpm during the intraoperative period. The baseline mean arterial pressure (MAP) of 82.42 ± 10.04 mmHg was maintained at 81 ± 7.32 mmHg during the intraoperative period. In all, 95.8% achieved early recovery with mean modified Aldrete's score of ≥9 at 10 minutes post-surgery. There was no episode of apnoea or desaturation. Conclusion: TIVA in combination with TIA minimally interferes with homeostasis and promotes early recovery in patients undergoing early excision and grafting in major burns.

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“…(a) As premedication: It can be administered by the oral (5-8 mg/kg), intramuscular (4-6 mg/kg), or iv (1-2 mg/kg) routes. The advantages include its analgesic properties and the ability to cause sedation without respiratory depression [48]. Because of its rapid onset of action, ketamine has been used as an IM induction drug in children and difficult to manage mentally retarded patients [49] Intranasal ketamine is these days widely studied for procedural sedation, a recent publication reviewed 11 studies and suggests that intranasal ketamine at doses up to 10 mg/kg appear to be safe in children with adequate analgesia at doses as low as 0.5 mg/kg.…”

Section: Other Uses Of Ketamine With Moderate Level Of Evidence (1) Imentioning

confidence: 99%

“…(1) Premedication: Ketamine can be administered orally (5–8 mg/kg), intramuscular (4–6 mg/kg), or IV (1–2 mg/kg) routes. The advantages include its analgesic properties and the ability to cause sedation without respiratory depression [ 48 ]. Because of its rapid onset of action, ketamine has been used as an IM induction drug in children and patients with intellectual disabilities [ 49 ].…”

Section: Consensus On Ketamine Use: What Does the Evidence Say?mentioning

confidence: 99%

Comeback of ketamine: resurfacing facts and dispelling myths

Kumar

Kohli

2021

Korean J Anesthesiol

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Initially known as CI-581, ketamine was first synthesized in 1962 as a replacement for phencyclidine (PCP). It is being used since then as a profound anesthetic and analgesic, in addition has bronchodilating, sedative and amnestic properties with the preservation of airway reflexes and sympathetic nervous system tone. Ketamine is always a stimulating topic of discussion since its discovery as the controversies regarding its usage in certain set of patients mostly overpowers its boon. In past 50 years, despite of potential benefits it has not gained acceptable popularity because of concerns of "emergence phenomenon", its use as substance of abuse and systemic side effects. Since 2012, ketamine has been subject to three World Health Organization (WHO) reviews addressing its international control. Researchers are widely studying this wonder drug since a decade worldwide. Many myths of ketamine regarding emergence phenomenon, its use in traumatic brain injury, open eye injury is getting busted in recent times. It's again getting popular in pre-hospital settings, critical care, emergency medicine, low dose acute pain services & adjuvant in regional anesthesia techniques. This review will highlight the current consensus on the various applications of ketamine in the light of available evidence in the literature.

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Premedication and induction of anaesthesia in paediatric patients

Cited by 67 publications

References 42 publications

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

<p>Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial</p>

Total intravenous anaesthesia with tumescent infiltration anaesthesia without definitive airway for early excision and skin grafting in a major burn - A prospective observational study

Comeback of ketamine: resurfacing facts and dispelling myths

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