Intranasal dexmedetomidine versus intranasal ketamine as a pre-anesthetic medication in pediatrics

Abstract

Background:Management of pre-operative anxiety is important in pediatric anesthesia. Ketamine and dexmedetomidine have been used as pre-anesthetic medications to alleviate stress .Objectives: This prospective randomized trial compared intranasal dexmedetomidine versus intranasal ketamine as a premedication in pediatric surgery.Patients and methods: Ninety children aged 1-8 years of either sex, scheduled for minor elective surgeries were randomly divided into 2 groups , 45 each. Thirty minutes before induction, group D received intranasal Dexmedetomidine (1 mcg/kg), while group K received intranasal Ketamine (2 mg/kg).Patients were compared for sedation score ,parent separation score , hemodynamics and possible side effects.Results: Sedation score was significantly lower in group D at 10, 20 and 30 minutes after drug administration. Parent separation score was in favor of group D at 10 and 20 minutes of drug administration and was comparable between both drugs at 30 minutes. Children in group D achieved satisfactory sedation of 91.1% and significant decrease in heart rate and blood pressure 30 minutes after drug administration and during the intraoperative period, while no difference was observed at 10 and 20 minutes . No difference in oxygen saturation between the 2 groups was observed. Shivering was significantly higher in group K while postoperative nausea and vomiting showed no significant difference between both groups.Conclusion: Intranasal dexmedetomidine and intranasal ketamine can be used effectively and safely as pre-anesthetic medications in children as regards sedation level and parental separation, with superiority of dexmedetomidine in sedation scores ,heart rate and blood pressure response.