Objective To evaluate the effect and security of premedication with intranasal dexmedetomidine combined with ketamine in children. Methods A total of 100 children received sclerotherapy on venous malformations, aged 1-5 years, American Society of Anesthesiologists Ⅰ-Ⅱ, were enrolled in this study. Fifty children were given intranasal dexmedetomidine at 2 μg/kg in one nostril and intranasal ketamine of 1 mg/kg in the other nostril as study group, and 50 children were given only dexmedetomidine at 2 μg/kg as control group. Premedication was performed at 30 min before operation. Heart rate (HR) and percutaneous oxygen saturation (SpO2) were recorded before premedication and 10 min(T1), 20 min(T2) and 30 min (T3) after premedication. When T3 after premedication modified observer’s assessment of alertness/sedation scale (MOAA/S) was assessed for children, sedation state. Parental separation anxiety scale (PSAS) was assessed for children emotional state. Sleep latency and wake-up time were recorded with intraoperative hypotension and bradycardia. Results The sedation assessed by the MOAA/S (≤; 3 points) in study group was significantly better than that in control group with statistical differences(P< 0.05). There was significant difference in PSAS scale between 2 groups (P< 0.05). There was no significant difference in HR and SpO2 except for the decrease in HR at T3 of control group (P< 0.05). The sleep latency was shorter and wake-up time was longer in study group when compared with those in control group (P< 0.05). There was no obvious hypotension and bradycardia in both groups. Conclusions Intranasal dexmedetomidine combined with ketamine would be a safe and simple premedication in children, which could sedate children well.
FAN Zhidan, JIN Shanliang, YU Guifang, CHEN Lijun
. Premedication with intranasal dexmedetomidine combined with ketamine in children[J]. Journal of Surgery Concepts & Practice, 2019
, 24(03)
: 264
-267
.
DOI: 10.16139/j.1007-9610.2019.03.018
[1] Cohen-Salmon D.Perioperative psychobehavioural changes in children[J]. Ann Fr Anesth Reanim,2010,29(4):289-300.
[2] Weksler N, Ovadia L, Muati G, et al.Nasal ketamine for peadiatric premedication[J]. Can J Anaesth,1993,40(2):119-121.
[3] Li BL, Yuen VW, Song XR, et al.Intranasal dexmedetomidine following failed chloral hydrate sedation in children[J]. Anaesthesia,2014,69(3):240-244.
[4] Mason KP, Lerman J.Review article: Dexmedetomidine in children: current knowledge and future applications[J]. Anesth Analg,2011,113(5):1129-1142.
[5] Peng K, Wu SR, Ji FH, et al.Premedication with dexmedetomidine in pediatric patients:a systematic review and meta-analysis[J]. Clinics (Sao Paulo),2014,69(11):777-786.
[6] Afonso J, Reis F.Dexmedetomidine: current role in anesthesia and intensive care[J]. Rev Bras Anestesiol,2012,62(1):118-133.
[7] Kain ZN, Hofstadter MB, Mayes LC, et al.Midazolani: effects on amnesia and anxiety in children[J]. Anesthesio-logy,2000,93(3):676-684.
[8] Mason KP, O'Mahony E, Zurakowski D, et al. Effects of dexmedetomidine sedation on the EEG in children[J]. Paediatr Anaesth,2009,19(12):1175-1183.
[9] 赵燕, 高巨, 林舜艳, 等. 右美托咪定术前滴鼻对全麻患儿术后行为改变的影响[J]. 临床麻醉学杂志,2016, 32(3):222-225.
[10] Mekitarian FE, Robinson F, de Carvalho WB, et al. Intranasal dexmedetomidine for sedation for pediatric computed tomography imaging[J]. J Pediatr,2015,166(5):1313-1315.
[11] Yao Y, Qian B, Lin Y, et al.Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective, rando-mized, double-blind, placebo-controlled trial[J]. Paediatr Anaesth,2015,25(5):492-498.
[12] Donahue PJ, Dineen PS.Emergence delirium following oral ketamine[J]. Anesthesiology,1992,77(3):604-605.
[13] McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children[J]. J Clin Anesth,2010,22(7):538-545.
[14] Zhang C, Hu J, Liu X, et al.Effects of intravenous dexmedetomidine on emergence agitation in children under sevoflurane anesthesia: a meta-analysis of randomized controlled trials[J]. PLoS One,2014,9(6):e99718.
[15] Yuen VM, Hui TW, Irwin MG, et al.A randomised comparison of two intranasal dexmedetomidine doses for premedication in children[J]. Anaesthesia, 2012,67(11):1210-1216.
