Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial.

Autor: Azemati S; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran., Keihani M; Hazrat Zeinab Hospital, Shiraz University of Medical Sciences, Shiraz, Iran., Sahmeddini MA; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran., Kanaani Nejad F; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran., Dehghanpisheh L; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran., Khosravi MB; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran., Asmarian N; Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Jazyk: angličtina
Zdroj: Iranian journal of medical sciences [Iran J Med Sci] 2024 Jul 01; Vol. 49 (7), pp. 421-429. Date of Electronic Publication: 2024 Jul 01 (Print Publication: 2024).
DOI: 10.30476/ijms.2023.99122.3118
Abstrakt: Background: The management of preoperative anxiety in pediatric patients, as well as its implications, has remained challenging for anesthesiologists. In this study, we compared the safety and efficacy of intranasal dexmedetomidine, midazolam, and ketamine as surgical premedication in children.
Methods: This double-blinded randomized clinical trial was conducted at two tertiary hospitals in January 2014, on 90 children aged between 2-7 years old. The participants' American Society of Anesthesiologists (ASA) physical status was I or II, and they were scheduled for elective unilateral inguinal herniorrhaphy. Using the block randomization method, the patients were randomly assigned to three groups, each receiving intranasal dexmedetomidine (2 µg/Kg), midazolam (0.2 mg/Kg), and ketamine (8 mg/Kg) 60 min before induction of anesthesia. Anxiety and sedation state were evaluated before drug administration, and then every 10 min for the next 50 min. Parental separation anxiety, mask acceptance, postoperative agitation, pain, nausea, and vomiting were also recorded and compared between these groups. All the statistical analyses were performed using SPSS software (version 21.0). P<0.05 was considered statistically significant.
Results: Ketamine indicated the strongest sedative effect 10, 20, and 30 min after administration of premedication (P<0.001, P=0.03, P=0.01, respectively). However, dexmedetomidine was more effective than other drugs after 40 and 50 min (P<0.001). Other variables indicated no statistically significant difference.
Conclusion: In case of emergencies, intranasal ketamine, with the shortest time of action, could be administered. Intranasal dexmedetomidine, which was revealed to be the most potent drug in this study, could be administrated 40-50 min before elective pediatric surgeries. Trial registration number: IRCT2013081614372N1.
Competing Interests: Mohammad Ali Sahmeddini and Naeimehossadat Asmarian, as the Editorial Board Members, were not involved in any stage of handling this manuscript. A team of independent experts was formed by the Editorial Board to review the article without their knowledge.
(Copyright: © Iranian Journal of Medical Sciences.)
Databáze: MEDLINE
Externí odkaz: