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Azemati S, Keihani M, Sahmeddini MA, Kanaani Nejad F, Dehghanpisheh L, Khosravi MB, Asmarian N. Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:421-429. [PMID: 39114639 PMCID: PMC11300945 DOI: 10.30476/ijms.2023.99122.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 08/10/2024]
Abstract
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.
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Affiliation(s)
- Simin Azemati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Keihani
- Hazrat Zeinab Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Kanaani Nejad
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang X, Ma L, Yang X, Zhou Y, Zhang X, Han F. Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate undergoing CT scan: a randomized controlled trial. BMC Anesthesiol 2024; 24:10. [PMID: 38166622 PMCID: PMC10759416 DOI: 10.1186/s12871-023-02397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is a great challenge to sedation for infants with cleft lip and palate undergoing CT scan, because there is the younger age and no consensus on the type, dosage, and route of drug administration. OBJECTIVE This study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate under imaging procedures. METHODS Infants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography (CT) scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time, Ramsay sedation scale, hemodynamic parameters during sedation, and adverse events. Data analyses involved the unpaired t-test, the repeated-measures analysis of variance test, and the continuity correction χ2 test. RESULTS One hundred five infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). The difference in Ramsay sedation scale values 20 min after administration was statistically significant between the groups. No statistically significant difference was found between the groups in changes in heart rate and respiratory rate. CONCLUSION Intranasal administration of dexmedetomidine in combination with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. However, it has a relatively prolonged duration of sedation and recovery time. TRIAL REGISTRATION ChiCTR2100049122, Clinical trial first registration date: 21/07/2021.
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Affiliation(s)
- Xiaodong Wang
- Department of Anesthesiology, Peking University Hospital of Stomatology, NO. 22 Zhongguancun South Avenue, Beijing, 100081, China
| | - Lian Ma
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Xudong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, NO. 22 Zhongguancun South Avenue, Beijing, 100081, China
| | - Yi Zhou
- Department of Anesthesiology, Peking University Hospital of Stomatology, NO. 22 Zhongguancun South Avenue, Beijing, 100081, China
| | - Xiang Zhang
- Department of Anesthesiology, Peking University Hospital of Stomatology, NO. 22 Zhongguancun South Avenue, Beijing, 100081, China
| | - Fang Han
- Department of Anesthesiology, Peking University Hospital of Stomatology, NO. 22 Zhongguancun South Avenue, Beijing, 100081, China.
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Cheng T, Liu Y, Li BH, Wu XR, Xia B, Yang XD. Dexmedetomidine versus midazolam as intranasal premedication for intravenous deep sedation in pediatric dental treatment. J Dent Sci 2024; 19:285-291. [PMID: 38303854 PMCID: PMC10829544 DOI: 10.1016/j.jds.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Optimal sedation management for pediatric dental treatment demands special focus as it's tubeless and shares a same oral space. The study was to evaluate dexmedetomidine compared to midazolam for intranasal premedication in pediatric dental treatment under intravenous deep sedation. Materials and methods A hundred children aged 3-7 years scheduled for elective dental treatment under intravenous deep sedation anesthesia were enrolled, of whom 50 children (Group D) were intranasally premedicated with 2.0 μg/kg dexmedetomidine and the remaining 50 children (Group M) received traditional 0.2 mg/kg midazolam. Acceptance rate of venipuncture was regarded as the primary endpoint. Results The acceptance rate of venipuncture in Group D and Group M were 76% versus 52%, respectively (P = 0.021). More children in Group M complained about bitter/sour taste than Group D (62% vs. 8%, P < 0.001). Intraoperatively, children in Group M were found to have more choking cough than Group D (30% vs. 9%, P = 0.003), and patients in Group M required more suction (18 [36%] in Group M vs. 4 [8%] in Group D, P = 0.001). There were no significant differences between the groups in the incidences of temporal hypoxemia (SpO2 ≤ 90%), however, two children in Group M experienced hypoxemia over 10 s. Conclusion Compared to the 0.2 mg/kg midazolam, children premedicated with 2.0 μg/kg intranasal dexmedetomidine showed superior venipuncture acceptance, had less intraoperative choking cough and required fewer suction. It seems to be a good alternative to midazolam as premedication for deep sedation in pediatric dental treatment.
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Affiliation(s)
- Tong Cheng
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Yun Liu
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Bing-Hua Li
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Xiao-Ran Wu
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Bin Xia
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
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Yıldırım MY, Ülgey A, Talih G, Doğan H, Güneş I. Evaluation of the Perioperative Effects of Dexmedetomidine and Midazolam-Ketamine Premedication in Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2023; 60:427-434. [PMID: 36803239 DOI: 10.3928/01913913-20221219-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
PURPOSE To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask tolerance, and separation from parents in children who would undergo strabismus surgery. METHODS A total of 74 patients aged 2 to 11 years, were divided into two groups. The dexmedetomidine group (n = 37) received 1 mcg/kg of dexmedetomidine and the midalozam-ketamine group (n = 37) received 0.1 mg/kg of midazolam and 7.5 mg/kg of ketamine combination intranasally. Mean arterial pressure, peripheral oxygen saturation, Ramsay Sedation Scale values, and heart rate were recorded before and after the premedication. The children's separation from the family scores were evaluated and recorded. The mask compliance was evaluated and recorded. Patients who developed oculocardiac reflex and were administered atropine were recorded. In the postoperative period, nausea and vomiting, recovery times, and postoperative agitation were evaluated. RESULTS Ramsay Sedation Scale scores, mask acceptance, and family separation scores were similar in both groups (P > .05). Oculocardiac reflex was observed more in the dexmedetomidine group (P = .048). Atro-pine requirement and postoperative nausea and vomiting rates were similar in both groups (P > .05). Mean arterial pressures and heart rates were significantly lower in the dexmedetomidine group during the pre-medication period. The recovery time was longer in the midazolam-ketamine group (P < .001). The incidence of postoperative agitation was significantly lower in the midazolam-ketamine group (P = .001). CONCLUSIONS The sedation efficacy of intranasal dexmedetomidine and midazolam-ketamine combination that were given in premedication was similar. Oculocardiac reflex was observed more with dexmedetomidine. The recovery time was prolonged in the midazolam-ketamine group, but postoperative agitation was observed less. [J Pediatr Ophthalmol Strabismus. 2023;60(6):427-434.].
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Lang B, Wang H, Fu Y, Zeng L, Huang L, Zhang Q, Chen S, Jia ZJ, Zhang L. Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2022; 22:399. [PMID: 36550437 PMCID: PMC9773574 DOI: 10.1186/s12871-022-01892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. We conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients. METHODS We searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study. RESULTS A total of 16 studies with 1066 patients were enrolled. Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure (SMD = -0.53, with 95% CI [-0.93, -0.13]) and heart rate (HR) (SMD = -1.39, with 95% CI [-2.84, 0.06]). Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level (61.76% vs 40.74%, RR = 1.53, with 95%CI [1.28, 1.83]), more rapid onset of sedation (SMD = -0.59, with 95%CI [-0.90, -0.28]) and more rapid recovery (SMD = -1.06, with 95%CI [-1.83, -0.28]). Current evidences also indicated that the differences of various adverse effects between two groups were not significant. CONCLUSIONS Given that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future. TRIAL REGISTRATION The protocol of present study was registered with PROSPERO (CRD42022321348).
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Affiliation(s)
- Bingchen Lang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Huiqing Wang
- grid.461863.e0000 0004 1757 9397Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuzhi Fu
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Linan Zeng
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Liang Huang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Qianqian Zhang
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Shouming Chen
- grid.461863.e0000 0004 1757 9397Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-jun Jia
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China ,grid.13291.380000 0001 0807 1581Department of Biopharmaceutics, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
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Dwivedi P, Patel TK, Bajpai V, Singh Y, Tripathi A, Kishore S. Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth 2022; 69:1405-1418. [PMID: 35970989 DOI: 10.1007/s12630-022-02305-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/16/2022] [Accepted: 05/17/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. SOURCE We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. PRINCIPAL FINDINGS Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. CONCLUSION The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. STUDY REGISTRATION PROSPERO (CRD42021262516); registered 22 July 2021.
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Affiliation(s)
- Priyanka Dwivedi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, 273008, India.
| | - Vijeta Bajpai
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Yashpal Singh
- Department of Anaesthesiology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Alka Tripathi
- Department of Ophthalmology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Suerkha Kishore
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Bagheri M, Soltani AE, Qorbani M, Sureda A, Faghihi T. Efficacy and safety of low dose oral ketamine for controlling pain and distress during intravenous cannulation in children: a double-blind, randomized, placebo-controlled trial. Korean J Pain 2022; 35:311-318. [PMID: 35768986 PMCID: PMC9251395 DOI: 10.3344/kjp.2022.35.3.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background Ketamine is widely used in infants and young children for procedural sedation and anesthesia. The aim of this study was to evaluate the efficacy and safety of low dose oral ketamine to control pain and distress in children during intravenous (IV) cannulation. Methods This is a prospective, randomized, double-blind study, including children aged between 3 and 6 years requiring a non-emergent IV-line placement. Children were randomly assigned to two groups, treated either with oral ketamine or a placebo. All patients were monitored for vital signs. Pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wong-Baker Faces Pain Rating Scale (WBFS) scales and sedation using a 5-point sedation score. The facility of IV-line placement was measured by a 3-point scale. Adverse effects were recorded after 1 and 24 hours. Results A total of 79 and 81 children were entered in the ketamine and placebo groups, respectively. The heart and respiratory rates increased significantly in the placebo group. The median CHEOPS 4 (95% confidence interval [CI]: 3, 4, P < 0.001) and WBFS 6 (95% CI: 4, 6, P < 0.001) scores decreased statistically in the ketamine group. IV-line placement was 50% easier in the ketamine group (95% CI: 37%, 63%, P < 0.001). No serious adverse effects were observed in all cases. Conclusions Low dose oral ketamine effectively decreased the pain and distress during IV cannulation in children without any significant adverse reactions.
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Affiliation(s)
- Mahdi Bagheri
- Department of Clinical Pharmacy, School of Pharmacy & Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ebrahim Soltani
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Antoni Sureda
- Research Group in Community Nutrition and Oxidative Stress and Health Research Institute of the Balearic Islands (IdISBa), University of Balearic Islands, Palma de Mallorca, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Toktam Faghihi
- Department of Clinical Pharmacy, School of Pharmacy & Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Cristoforo T, Gonzalez D, Bender M, Uy G, Papa L, Ben Khallouq BA, Clark M, Carr B, Cramm K. A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:479-486. [PMID: 35600518 PMCID: PMC9120296 DOI: 10.1007/s40653-021-00402-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 06/03/2023]
Abstract
Identifying non-invasive methods for anxiolysis is becoming increasingly important in the pediatric emergency department (ED). Few studies have examined the use of intranasal (IN) ketamine for procedural anxiolysis. We aim to evaluate if IN ketamine provides satisfactory anxiolysis for patients undergoing laceration repair based on anxiety and sedation scoring. We also evaluated the feasibility of using IN ketamine in future trials based on its tolerability and side-effects. A pilot study evaluating IN ketamine in the treatment of procedural anxiety for patients, 2 years and older, weighing 40 kg or less, presenting to the pediatric ED with lacerations. The need for anxiolysis was defined by an elevated modified-Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) score. Patients received 5 mg/kg of IN ketamine in addition to topical anesthesia, mYPAS-SF scoring before and during the procedure, sedation scoring, adverse events, vital signs, age, weight, laceration size and location, and satisfaction surveys were recorded. Twenty-five patients were enrolled, with mean age of 61 ± 29.2 months and mean weight of 21 ± 6.4 kg. Lacerations were located on the face, extremities, and groin with mean size of 2.1 cm. A decrease in anxiety levels was observed, from median m-YPAS-SF score of 66.7 (62.50-80.2) to 33.3 (27.09-52.00), p < 0.001. Among the patients, 92% (n = 23) were less anxious during the procedure. IN ketamine appears to be safe and well-tolerated with a positive impact on procedural anxiety. A dosage of 5 mg/kg is a reasonable starting point, as 80% of patients had appropriate anxiolysis.
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Affiliation(s)
- Thomas Cristoforo
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Dulce Gonzalez
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Mark Bender
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Geraldine Uy
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Linda Papa
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Bertha A. Ben Khallouq
- Research Department, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL USA
| | - Mark Clark
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Brandon Carr
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Kelly Cramm
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
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9
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Abusinna RG, Algharabawy WS, Mowafi MM. Comparative evaluation of intranasal midazolam, dexmedetomidine, ketamine for their sedative effect and to facilitate venous cannulation in pediatric patients: A prospective randomized study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2033074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rasha Gamal Abusinna
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wael Sayed Algharabawy
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Mostafa Mowafi
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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10
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Cossovel F, Trombetta A, Ramondo A, Riccio G, Ronfani L, Saccari A, Cozzi G, Barbi E. Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam. Ital J Pediatr 2022; 48:5. [PMID: 35012598 PMCID: PMC8751084 DOI: 10.1186/s13052-021-01196-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-painful diagnostic procedures require an inactive state for a prolonged time, so that sedation is often needed in younger children to perform the procedures. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg). One of the limits of this approach is that the onset of action is quite delayed (up to 55 min) and poorly predictable. We chose to compare this association with intranasal-ketamine and intranasal-dexmedetomidine. METHODS This is a "pre-post" study. The study population included the first forty children receiving sedation with the "new" combination intranasal ketamine (3 mg/kg) and intranasal dexmedetomidine (4 mcg/kg) compared to a historical cohort including the last forty children receiving sedation with our standard of care combination of intranasal dexmedetomidine (4mcg/kg) and oral midazolam (0,5 mg/kg). RESULTS The association intranasal dexmedetomidine and intranasal ketamine allowed for a significantly shorter sedation induction time than the combination intranasal dexmedetomidine and oral midazolam (13,5 min versus 35 min). Both group's cumulative data showed a correlation between age and sedation effectiveness, with younger children presenting a higher success rate and shorter induction time (p 0,001). CONCLUSIONS This study suggests that the ketamine and dexmedetomidine intranasal association may have a shorter onset of action when compared to intranasal dexmedetomidine and oral midazolam.
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Affiliation(s)
- Francesca Cossovel
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Andrea Trombetta
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy.
| | - Augusto Ramondo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Guglielmo Riccio
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessia Saccari
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria 65/1, 34137, Trieste, Italy
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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11
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Frestadius A, Grehn F, Kildal M, Huss F, Fredén F. Intranasal dexmedetomidine and rectal ketamine for young children undergoing burn wound procedures. Burns 2021; 48:1445-1451. [PMID: 34895793 DOI: 10.1016/j.burns.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Safe and effective methods for sedation and analgesia in pediatric burn patients are strongly warranted. This retrospective study of electronic health care records aims to evaluate the safety and efficacy of intranasal dexmedetomidine combined with rectal ketamine as procedural sedation for young children undergoing dressing changes and debridement of burn wounds. METHODS Documentation was analyzed from 90 procedures in 58 pediatric patients aged <5 years. Safety and efficacy of the method were assessed based on documentation for complications, adverse effects, pain level, level of sedation and preoperative and recovery time. RESULTS All 90 sedations were completed without significant adverse events with acute airway management or medical intervention. The combination of dexmedetomidine-ketamine produced acceptable analgesia during the procedure and effectively relieved postoperative pain. However, the approach was insufficient for 7/58 patients (7.8%); these patients were converted from the dexmedetomidine-ketamine combination to intravenous anesthesia. In 23% of the cases an extra dose of either ketamine of dexmedetomidine was administered. Moreover, there were two cases of delayed awakening with recovery time >120 min. CONCLUSION The drug combination intranasal dexmedetomidine and rectal ketamine is a safe and reliable approach for procedural sedation and analgesia in pediatric patients undergoing burn wound procedures, producing a clinically stable sedative condition requiring only basic monitoring.
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Affiliation(s)
- Andrea Frestadius
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden.
| | - Filip Grehn
- Vrinnevi County Hospital, 601 82 Norrköping, Sweden.
| | - Morten Kildal
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, 752 36 Uppsala, Sweden.
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, 752 36 Uppsala, Sweden.
| | - Filip Fredén
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, 752 36 Uppsala, Sweden.
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Heydari F, Khalilian S, Golshani K, Majidinejad S, Masoumi B, Massoumi A. Topical ketamine as a local anesthetic agent in reducing venipuncture pain: A randomized controlled trial. Am J Emerg Med 2021; 48:48-53. [PMID: 33836388 DOI: 10.1016/j.ajem.2021.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
AIM Pain control is an important aspect of ED patient management, and there are many different protocols used around the world influenced by both availability of local resources as well as staff competency and experience. This study aims to evaluate the use of topical ketamine in acute pain reduction by directly comparing it to lidocaine-prilocaine (EMLA) cream. MATERIALS AND METHODS In this randomized clinical trial, 300 adult patients classified as level 4 or 5 by ESI triage system were enrolled. These patients were divided randomly into three groups. The site of venipuncture was covered with 2 g of topical ketamine cream 10% in group one, 2 g of 5% EMLA cream in group two, and finally, in group 3 (control group), was covered with placebo (2 g of cold cream). The primary end point of the study was reported pain severity with secondary end points being onset of local anesthesia as well as any side effects noted. RESULTS The data gathered showed pain score during venipuncture in both intervention groups were significantly lower when compared to the control group (P < 0.05). However, pain score did not differ between the 2 intervention groups (P = 0.395). There was no statistically significant difference between the ketamine or EMLA in onset of local anesthesia (P = 0.419). We noted itching and irritation was significantly higher in the EMLA group when compared to ketamine(P < 0.05). CONCLUSION This study showed that local cutaneous ketamine is as effective as EMLA in relieving pain during venipuncture.
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Affiliation(s)
- Farhad Heydari
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sanaz Khalilian
- Emergency Department, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keihan Golshani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Majidinejad
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Masoumi
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Abaris Massoumi
- Department of General Surgery, Ealing Hospital, London North West University Healthcare NHS Trust, London, Uxbridge Road, Southall UB1 3HW, UK
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13
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Khoshrang H, Emir Alavi C, Rimaz S, Mirmansouri A, Farzi F, Biazar G, Atrkarroushan Z, Sabet Khadem N. Efficacy of intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:539-543. [PMID: 34820060 PMCID: PMC8590412 DOI: 10.22088/cjim.12.4.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/01/2020] [Accepted: 12/26/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Pediatric patients feel significant fear and anxiety when undergoing surgeries. The ideal drug and its administration route have not been found yet. The aim of this study was to compare the efficacy and safety of intranasal (IN) ketamine and midazolam as premedication in children. METHODS We studied 71 eligible pediatric patients undergoing elective urologic surgeries, aged 2 to 6 years. The degree of sedation and separation scores was compared between the two groups. Additionally, hemodynamic parameters, before premedication, after induction of anesthesia, and during surgery were documented and compared between two groups. Postoperatively, any side effect was recorded as well. RESULTS Finally, the data from 71 children were analyzed. Recovery time was significantly longer in group K (ketamine) compared to group M (midazolam); 27.86±4.42 vs 38.19± 6.67 minutes respectively (P=0.01). No significant difference was observed in terms of sedation score between two groups of K & M; 3.29±0.78 vs 3 ±0.71 respectively (P=0.17), and not regarding separation score; 2.51±0.61 & 2.31±0.52 respectively (P=0.01). Vital signs were kept within the physiological limits in both groups with no marked fluctuations. CONCLUSION To produce sedation in young children, both midazolam and ketamine were effective and safe by IN route.
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Affiliation(s)
- Hossein Khoshrang
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Cyrus Emir Alavi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Siamak Rimaz
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Ali Mirmansouri
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran,Correspondence: Gelareh Biazar, Anesthesiology Research Center, Al-zahra Hospital, Guilan University of Medical Sciences, Namjoo Street, Rasht, 4144654839, Iran. E-mail: , Tel: 0098 1333369328, Fax: 0098 1333369024
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14
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Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study. Cardiol Young 2019; 29:1189-1195. [PMID: 31451130 DOI: 10.1017/s1047951119001835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are several agents used for conscious sedation by various routes in children. The aim of this prospective randomised study is to compare the effectiveness of three commonly used sedatives: intranasal ketamine, intranasal midazolam, and oral chloral hydrate for children undergoing transthoracic echocardiography. METHODS Children who were referred to paediatric cardiology due to a heart murmur for transthoracic echocardiography were prospectively randomised into three groups. Seventy-three children received intranasal midazolam (0.2 mg/kg), 72 children received intranasal ketamine (4 mg/kg), and 72 children received oral chloral hydrate (50 mg/kg) for conscious sedation. The effects of three agents were evaluated in terms of intensity, onset, and duration of sedation. Obtaining high-quality transthoracic echocardiography images (i.e. absence of artefacts) were regarded as successful sedation. Side effects due to medications were also noted. RESULTS There was no statistical difference in terms of sedation success rates between three groups (95.9, 95.9, and 94.5%, respectively). The median onset of sedation in the midazolam, ketamine, and chloral hydrate was 14 minutes (range 7-65), 34 minutes (range 12-56), and 40 minutes (range 25-57), respectively (p < 0.001 for all). However, the median duration of sedation in study groups was 68 minutes (range 20-75), 55 minutes (range 25-75), and 61 minutes (range 34-78), respectively (p = 0.023, 0.712, and 0.045). Gastrointestinal side effects such as nausea and vomiting were significantly higher in the chloral hydrate group (11.7 versus 0% for midazolam and 2.8% for ketamine, respectively, p = 0.002). CONCLUSION Results of our prospectively randomised study indicate that all three agents provide adequate sedation for successful transthoracic echocardiography. When compared the three sedatives, intranasal midazolam has a more rapid onset of sedation while intranasal ketamine has a shorter duration of sedation. Intranasal ketamine can be used safely with fewer side effects in children undergoing transthoracic echocardiography.
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15
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Hartling L. Intranasal ketamine for anesthetic premedication in children: a systematic review. Pain Manag 2018; 8:495-503. [PMID: 30394192 DOI: 10.2217/pmt-2018-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM In children, intravenous anesthetic premedication can be distressing. Intranasal (IN) ketamine offers a less invasive approach. MATERIALS AND METHODS We included randomized trials of IN ketamine in anesthetic premedication in children 0-19 years. We performed electronic searches of MEDLINE, EMBASE, Google Scholar, CINAHL, Cochrane Library, Web of Science, Scopus, clinical trial registries and conference proceedings. RESULTS Among the 23 trials (n = 1680) included, IN ketamine adequately sedated 220/311 (70%) for face mask application, 217/308 (70%) for caregiver separation, 200/371 (54%) for iv. insertion and 19/30 (63%) for monitor application. Vomiting was the most common adverse effect (35/1579 [2.2%]). CONCLUSION There is a need for sufficiently powered, methodologically rigorous trials, using psychometrically evaluated, objective outcome measures to meaningfully inform practice.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Kyle Canton
- Division of Emergency Medicine, Western University, London, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | - Amit Shah
- Division of Emergency Medicine, Western University, London, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada
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16
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Ezz HAA. Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Hoda Alsaid Ahmed Ezz
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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17
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Abdolkarimi B, Zareifar S, Golestani Eraghi M, Saleh F. Comparison Effect of Intravenous Ketamine with Pethidine for Analgesia and Sedation during Bone Marrow Procedures in Oncologic Children: A Randomized, Double-Blinded, Crossover Trial. Int J Hematol Oncol Stem Cell Res 2016; 10:206-211. [PMID: 27928474 PMCID: PMC5139939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/10/2016] [Indexed: 10/30/2022] Open
Abstract
Background: Children suffering from cancer always require pain relief and reduce anxiety when undergoing painful procedures. The aim of this study is to compare the effect of pethedine and ketamine administration in cancer-diagnosed children undergoing bone marrow aspiration and biopsy procedures. Subjects and Methods: A randomized, double-blinded, crossover trial was carried out on 57 children undergoing painful procedures (bone marrow aspiration/biopsy). Patients were randomly assigned in a double-blinded fashion to receive either intravenous pethedine (1 mg/kg/dose) or ketamine (1 mg/kg/dose), respectively. The effectiveness of the drug was measured utilizing three parameters; perception of procedural pain with Wong-Baker Faces Pain Rating Scale and Richmond Agitation-Sedation Scale (RASS), hemodynamic changes and respiration and the frequency of vomiting nausea score. Results: Additionally, hemodynamic stability and pain control were significantly better in the patients receiving ketamine (p<0.05, at 0, 15, 30 min). Nausea and vomiting were more frequent in Group K than in Group M but there were no significant differences. No serious complications were observed. Conclusion: This study showed that intravenous ketamine generated a superior clinical effect in decreased pain. Ketamine may also be recommended as a reasonable option before oncology procedures in children suffering from cancer.
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Affiliation(s)
- Babak Abdolkarimi
- Assistant Professor of Hematology-Oncology, Department of Pediatrics, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Soheila Zareifar
- Associate Professor of Hematology-Oncology, Department of Pediatrics, Amir Oncology Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Golestani Eraghi
- Fellowship in Intensive Care, Anesthesiologist, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Fellowship in Intensive Care, Anesthesiologist, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fazl Saleh
- Fellowship of Hematology-Oncology Department of Pediatrics, Amir Oncology Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Yanmaz LE, Dogan E, Okur S, Okumus Z, Ersoz U. Comparison of the effects of intranasal and intramuscular administrations of zolazepam-tiletamine combination on intraocular pressure in cats. Vet Ophthalmol 2016; 19 Suppl 1:115-8. [DOI: 10.1111/vop.12400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Latif Emrah Yanmaz
- Department of Surgery; Faculty of Veterinary Medicine; Ataturk University; Erzurum 25240 Turkey
| | - Elif Dogan
- Department of Surgery; Faculty of Veterinary Medicine; Ataturk University; Erzurum 25240 Turkey
| | - Sitkican Okur
- Department of Surgery; Faculty of Veterinary Medicine; Ataturk University; Erzurum 25240 Turkey
| | - Zafer Okumus
- Department of Surgery; Faculty of Veterinary Medicine; Ataturk University; Erzurum 25240 Turkey
| | - Ugur Ersoz
- Department of Surgery; Faculty of Veterinary Medicine; Ataturk University; Erzurum 25240 Turkey
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Affiliation(s)
- C. R. Bailey
- Evelina London Children's Hospital; Guy's and St. Thomas' NHS Foundation Trust; London UK
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