A randomised study of intranasal dexmedetomidine and oral ketamine for premedication in children

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Abstract

We studied the effects of intranasal dexmedetomidine combined with oral ketamine for premedication in children. One hundred and sixty children aged between 2 and 6 years were randomly allocated to one of four groups: 1 μg.kg−1 intranasal dexmedetomidine with 3 mg.kg−1 oral ketamine (Group 1); 1 μg.kg−1 intranasal dexmedetomidine with 5 mg.kg−1 oral ketamine (Group 2); 2 μg.kg−1 intranasal dexmedetomidine with 3 mg.kg−1 oral ketamine (Group 3); and 2 μg.kg−1 intranasal dexmedetomidine with 5 mg.kg−1 oral ketamine (Group 4). Sedation levels 10, 20 and 30 min after premedication were evaluated using a 5-point sedation scale. A 4-point emotional state score was used to evaluate patients when they were separated from their parents and their response to intravenous cannulation or facemask application. Approximately 90% of patients readily accepted premedication and onset times of acceptable sedation were similar in all four groups. Patients in Group 4 were significantly more sedated than those in Group 1 after 30 min (p = 0.036). A significantly higher proportion of patients in Group 3 (84%) and Group 4 (87%) accepted intravenous cannulation compared with those in Group 1 (40%) and Group 2 (54%) (p = 0.001). We conclude that the administration of 2 μg.kg−1 intranasal dexmedetomidine and 3 mg.kg−1 oral ketamine was the optimal combination, with children being easily separated from their parent, accepting intravenous cannulation and without causing excessive side-effects or postoperative complications.

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