Comparación de la administración intranasal de dexmedetomidina y ketamina para premedicación pediátrica: estudio aleatorizado

Introduction and objectives

Paediatric patients are given premedication to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child-friendly method of administration is therefore needed.

We administered the Faces, Legs, Activity, Cry and Consolability (FLACC) scale in patients receiving intranasal dexmedetomidine and ketamine to compare their reactions to insertion of a catheter for induction of general anaesthesia in the operating room.

Methods

This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 and 2, scheduled for general anaesthesia were enrolled. Presedation behaviour was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received ketamine 5 mg/kg intranasally. After 45 minutes, patients were transferred to the operating table where intravenous cannulation was performed and patient response to needle insertion was assessed using the FLACC scale. Vital signs, including heart rate, respiratory rate, and blood oxygen levels were monitored. Side effects such as náusea, vomiting, and agitation were also recorded.

Results

The FLACC score was significantly higher in Group D vs. Group K (P=.001). Mean heart rate was significantly (P=.001) lower in Group D vs. Group K. However, adverse events occurred in 8% of patients who received ketamine.

Conclusions

Intranasal ketamine at a dose of 5 mg/kg is clinically more effective for premedication in children aged 2-10 years compared with intranasal dexmedetomidine at a dose of 1 mcg/kg.