Ketamine‐dexmedetomidine combination for sedation in pediatric major surgery in a low‐income country

Abstract

Anorectal malformations are one of the most frequent congenital malformations treated by pediatric surgeons. In low‐income countries, the surgical and anesthetic management of children in need of these procedures can be challenging. Limited oxygen supply, lack of equipment, especially pediatric, and intensive care units make the use of regional anesthesia appealing. We present a series of four cases of anorectal malformations corrections in Guinea Bissau, in children up to 13 months of age, under regional anesthesia and sedation with ketodex, a mixture of ketamine and dexmedetomidine (in a proportion of 1 mg to 1 μg). No child developed respiratory depression requiring airway intervention or supplemental oxygen, or had hemodynamic instability.

Editorial: Ethics and short‐term surgical visits to low‐income countries

“…The team report that such resource deficits "make the use of regional anesthesia appealing". 1 In more detail, the team operated using regional anesthesia and sedation with ketodex, a mixture of ketamine and dexmedetomidine (in a proportion of 1 mg to 1 μg). The procedures were successful: the anorectal malformations were corrected, and no child developed respiratory depression requiring airway or supplemental oxygen or had hemodynamic instability.…”

“…A recent article in this journal 1 describes a European surgical team's visit to a pediatric hospital in Guinea‐Bissau. The team present four anorectal malformation corrections in children under 13 months carried out in a hospital with few resources, limited oxygen supply and monitoring equipment, and no specific pediatric anesthetic machines or intensive care units.…”

“…The team present four anorectal malformation corrections in children under 13 months carried out in a hospital with few resources, limited oxygen supply and monitoring equipment, and no specific pediatric anesthetic machines or intensive care units. The team report that such resource deficits “make the use of regional anesthesia appealing” 1 . In more detail, the team operated using regional anesthesia and sedation with ketodex, a mixture of ketamine and dexmedetomidine (in a proportion of 1 mg to 1 μg).…”

“…And later, “[c]linical experience regarding the use of ketodex in the pediatric population are still limited, and further studies are required. The adverse effects of other drugs, such as benzodiazepines, propofol, and opioids, leave an opportunity to consider alternative agents that may improve the outcome and minimize the risks” 1 …”

“…Ketodex is an expensive option; its cost means it is not used in many high‐income countries. Vila Moutinho Tavares et al remark that ketamine can be combined with sedatives that are cheaper than dexmedetomidine, such as propofol or midazolam, “which could be a plus in developing countries” 1 . Given the likely barriers to the uptake of the ketodex in those countries, why not seek improved understanding about those combinations?…”