Comparison of the use of nebulized dexmedetomidine, ketamine, and a mixture thereof as premedication in pediatric patients undergoing tonsillectomy: a double-blind randomized study
NaderA El Gamal, Mohammad HazemI Ahmad Sabry, Nourhan Elhelw, RamadanA Ammar
Abstract
Purpose To compare the use of nebulized dexmedetomidine, nebulized ketamine, and a mixture thereof as premedication in children aged 3–6 years undergoing tonsillectomy.Patients and methods Seventy-five patients were assigned randomly to three groups (n=25/group) that received nebulized dexmedetomidine (3 μg/kg; group A), nebulized ketamine (3 mg/kg; group B), and nebulized dexmedetomidine (1.5 μg/kg) plus nebulized ketamine (1.5 mg/kg; group C). The drugs were prepared in 0.9% normal saline, and the children underwent nebulizer sessions 30 min before surgery. The primary end point was the level of sedation, measured 30 min after nebulization using Ramsay scale. We also measured ease of parental separation, face mask acceptance, hemodynamic stability, postoperative analgesia requirement (using a visual analog scale), and recovery and discharge times.Results The three groups did not differ in terms of age, sex, or weight. The level of sedation (in 15 and 30 min) was higher in group A than in group B (P=0.039), but no significant difference in sedation score was detected among the three groups. Ease of parental separation and face mask acceptance were better in group A than in group B (P=0.037). The groups did not differ in terms of analgesia requirement, recovery time, or discharge time.Conclusion Nebulized dexmedetomidine achieves better sedation and facilitates parental separation and face mask acceptance during inhalational induction compared with nebulized ketamine and a mixture of nebulized ketamine and dexmedetomidine, with no effect on hemodynamic stability or recovery or discharge time.