Qiao Hui, Xie Zhi, Jia Jie
Department of Anesthesiology, The Eye, Ear, Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
Department of Anesthesiology, Shanghai Deji Hospital, Qingdao University, Shanghai, China.
BMC Anesthesiol. 2017 Nov 29;17(1):158. doi: 10.1186/s12871-017-0454-8.
Preoperative anxiety is common in pediatric patients. When dexmedetomidine is used alone for sedation as premedication, children tend to awaken when separated from their parents, and body movements occur during invasive procedures. We tested the hypothesis that the combination of dexmedetomidine and ketamine may be a useful premedication to alleviate preoperative anxiety and improve cooperation during intravenous cannulation in pediatric patients, while producing minimal adverse events.
A total of 135 children, aged 2-5 years and American Society of Anesthesiologists status I-II, scheduled for eye surgery were randomly allocated to receive intranasal dexmedetomidine 2.5 μg/kg (group D), oral ketamine 3 mg/kg and intranasal dexmedetomidine 2 μg/kg (group DK), or oral ketamine 6 mg/kg (group K) 30 min before surgery. Sedation state was evaluated every 10 min after premedication and emotional state was assessed during separation from their parents and peripheral intravenous cannulation. Adverse events were recorded for 24 h postoperatively. The primary endpoint was the rate of successful intravenous cannulation.
The rate of successful venous cannulation was 47% with dexmedetomidine alone, 68% with ketamine alone, and 80% with combined premedication (P = 0.006). The rate of satisfactory separation from parents was not different among groups. The incidence of adverse events was higher in group K compared with the other two groups (postoperative vomiting, P = 0.0041; respiratory-related complications during the perioperative period, P = 0.0032; and postoperative psychological/psychiatric adverse events, P = 0.0152).
The combination of intranasal dexmedetomidine 2 μg/kg and oral ketamine 3 mg/kg produces satisfactory separation from parents and more successful venous cannulation, allowing children to smoothly accept induction of general anesthesia.
Chinese Clinical Trial Register (Unique identifier: ChiCTR-TRC-14004475 , Date of registration: 2 April 2014).
术前焦虑在儿科患者中很常见。当单独使用右美托咪定作为术前用药进行镇静时，儿童在与父母分离时往往会醒来，并且在侵入性操作过程中会出现身体移动。我们检验了这样一个假设，即右美托咪定与氯胺酮联合使用可能是一种有用的术前用药，可减轻儿科患者的术前焦虑并改善静脉置管期间的配合度，同时产生最少的不良事件。
总共135名年龄在2至5岁、美国麻醉医师协会分级为I-II级、计划接受眼科手术的儿童被随机分配，在手术前30分钟接受鼻内给予2.5μg/kg右美托咪定（D组）、口服3mg/kg氯胺酮和鼻内给予2μg/kg右美托咪定（DK组）或口服6mg/kg氯胺酮（K组）。术前用药后每10分钟评估一次镇静状态，并在与父母分离和外周静脉置管期间评估情绪状态。记录术后24小时的不良事件。主要终点是静脉置管成功率。
单独使用右美托咪定的静脉置管成功率为47%，单独使用氯胺酮为68%，联合术前用药为80%（P = 0.006）。各组与父母满意分离的比例无差异。与其他两组相比，K组的不良事件发生率更高（术后呕吐，P = 0.0041；围手术期呼吸相关并发症，P = 0.0032；以及术后心理/精神不良事件，P = 0.0152）。
鼻内给予2μg/kg右美托咪定与口服3mg/kg氯胺酮联合使用可实现与父母的满意分离，并使静脉置管更成功，从而使儿童能够顺利接受全身麻醉诱导。
中国临床试验注册中心（唯一标识符：ChiCTR-TRC-14004475，注册日期：2014年4月2日）。
