The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

Gao, Pengfei; Li, Shiyue; Li, Yue; Zhao, Ling; Luo, Qiang; Yang, Jiamin

doi:10.1016/j.heliyon.2022.e11166

Cited by 11 publications

(6 citation statements)

References 32 publications

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“…Indeed, strategies to reduce these symptoms have been used, and the combination of ketamine and dexmedetomidine appears to be very beneficial, particularly in the ICU or in unstable patients [22][23][24][25][26][27]. When compared to the other more well-known association between ketamine and propofol (keto-fol), the literature shows better tolerance because it reduces nausea and vomiting, as well as respiratory depression [9][10][11][12][13][14][15][16][18][19][20][21][22][23]26,27], which is already low with keto-fol when compared to propofol [28,29]. Neither ketamine nor dexmedetomidine causes respiratory depression [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Neither ketamine nor dexmedetomidine causes respiratory depression [6][7][8]. In addition, the impact of keta-dex and keto-fol on the cardiovascular system is minimal since both combinations have a synergistic effect on the cardiovascular profile [21][22][23][24][25][26]. Ketamine enhances central catecholaminergic tone with increased levels of circulating norepinephrine and dopamine, whereas dexmedetomidine can cause bradycardia and vasodilation, especially at higher doses.…”

Section: Discussionmentioning

confidence: 99%

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Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

Riccardi¹,

Serra

Iaco

et al. 2023

JCM

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This retrospective observational study evaluated the safety and efficacy of the ketamine and dexmedetomidine combination (keta-dex) compared to ketamine or dexmedetomidine alone for sedation of patients with acute respiratory distress due to COVID-19 pneumonia who require non-invasive ventilation. The following factors were assessed: tolerance to the ventilation, sedation level on the Richmond Agitation-Sedation Scale (RASS), hemodynamic and saturation profile, adverse effects, and discontinuation or mortality during ventilation. The study included 66 patients who underwent sedation for non-invasive ventilation using keta-dex (KETA-DEX group, n = 22), ketamine (KET group, n = 22), or dexmedetomidine (DEX group, n = 22). The DEX group showed a slower sedation rate and a significant reduction in blood pressure compared to the KETA-DEX group (p < 0.05). An increase in blood pressure was recorded more frequently in the KET group. No reduction in oxygen saturation and no deaths were observed in any of the groups. None of the patients discontinued ventilation due to intolerance. The mean duration of sedation was 28.12 h. No cases of delirium were observed in any of the groups. Overall, keta-dex was associated with faster sedation rates and better hemodynamic profiles compared to dexmedetomidine alone. Keta-dex is effective and safe for sedation of uncooperative patients undergoing non-invasive ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

Riccardi¹,

Serra

Iaco

et al. 2023

JCM

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“…Dexmedetomidine is the latest sedative of the three and it is not officially approved for use in paediatric procedural sedation in the EU, but it is widely used off-label. There is plenty of literature on the dosing, efficacy and safety of dexmedetomidine for paediatric procedural sedation [35 ▪▪ ,36,37 ▪ ]. Although induction of sedation with dexmedetomidine and recovery after the procedure take longer, it has an advantage that airway and spontaneous breathing are not impaired [36,38,39 ▪ ].…”

Section: Sedative Medicationsmentioning

confidence: 99%

“…There is plenty of literature on the dosing, efficacy and safety of dexmedetomidine for paediatric procedural sedation [35 ▪▪ ,36,37 ▪ ]. Although induction of sedation with dexmedetomidine and recovery after the procedure take longer, it has an advantage that airway and spontaneous breathing are not impaired [36,38,39 ▪ ]. Cardiovascular adverse effects such as bradycardia and hypotension are described and occur in 0–22 and 0.6–3.2% of cases, respectively, depending on dosage and rate of injection.…”

Section: Sedative Medicationsmentioning

confidence: 99%

Safety and quality in paediatric procedural sedation: what really matters?

Röher

Becke‐Jakob

Eich

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThis review gives an overview of the safety aspects for paediatric procedural sedation and a discussion of possibilities for optimizing structure, processes and outcomes.Recent findingsProcedural sedation in paediatric patients is performed by providers of different specialties and compliance with safety standards is a basic requirement regardless of provider specialty. This includes preprocedural evaluation, monitoring, equipment and profound expertise of sedation teams. The choice of sedative medications and the possibility of incorporating nonpharmacological methods play an important role for optimal outcome. In addition, an ideal outcome from the patient's perspective includes optimized processes and clear and empathetic communication.SummaryInstitutions providing paediatric procedural sedation must ensure the comprehensive training of sedations teams. Furthermore, institutional standards for equipment, processes and optimal choice of medication depending on performed procedure and comorbidities of the patient must be established. At the same time, organizational and communication aspects should be considered.

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“…Some studies have shown that the anesthesia recovery time is prolonged and the incidence of bradycardia increases significantly after intravenous Dex infusion. [8][9][10] This is mainly attributed to the different doses and methods of Dex administration. Although the complications are always transient and reversible, timely attention is required to avoid serious adverse consequences.…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial

Zheng,

Fang,

Zhang

et al. 2024

DDDT

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Dexmedetomidine (Dex) is a potent and highly selective α2-adrenergic receptor agonist. Within an appropriate dose range, Dex can effectively attenuate the surgical stress response, provide intraoperative hemodynamic stability, and improve the patient recovery quality. High-dose Dex can delay patient awakening from anesthesia and increase the incidence of bradycardia. This randomized controlled trial aimed to investigate the effects of low-dose intravenous Dex premedication in patients undergoing laparoscopic cholecystectomy (LC). Material and Methods: In total, 100 patients undergoing LC were equally randomized into Group C (premedication with saline) and Group D (premedication with 0.5 µg/kg Dex). The patients were premedicated with saline or Dex, depending on the group, before anesthesia induction. Following this, anesthesia induction and endotracheal intubation was performed, and anesthesia was maintained during surgery. Following the completion of the surgery, the patients were transferred the post-anesthesia care unit (PACU) and stayed there until they met the PACU discharge criteria. The hemodynamic parameters, consumption of anesthetics, surgical duration, postoperative awakening time, extubation time, postoperative pain, and complications were recorded. Results: No significant differences were observed in the heart rate (HR) and mean arterial pressure (MAP) between the two groups before premedication (P>0.05). The MAP and HR immediately after endotracheal intubation and immediately after extubation were significantly lower in Group D than in Group C (P<0.05 for both). The incidence of bradycardia was significantly higher in Group D than in Group C (P<0.05), while atropine was used in neither group. Propofol and remifentanil consumption was significantly lower in Group D than in Group C (P<0.05). The postoperative awakening and extubation times were significantly shorter in Group D than in Group C (P<0.05). The postoperative visual analog scale scores for pain and incidence of nausea, vomiting, and cough were significantly lower in Group D than in Group C (P<0.05 for all). Conclusion: Our data suggest that premedication with dexmedetomidine (0.5 µg/kg) before general anesthesia induction can effectively attenuate intraoperative stress response and postoperative pain, maintain perioperative hemodynamic stability, and decrease the incidence of adverse events, which might be an effective and safe anesthetic protocol during LC worthy of further clinical application.

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The comparison of ketamine-dexmedetomidine (ketadex) and ketamine-propofol (ketofol) for procedural sedation in pediatric patients: A meta-analysis of randomized controlled trials

Cited by 11 publications

References 32 publications

Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

Uncovering the Benefits of the Ketamine–Dexmedetomidine Combination for Procedural Sedation during the Italian COVID-19 Pandemic

Safety and quality in paediatric procedural sedation: what really matters?

Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial

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