Qiao Hui, Zhuang Yan, Lv Peipei, Ye Zhou, Lu Yu, Jia Jie
Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Transl Pediatr. 2024 Aug 31;13(8):1327-1335. doi: 10.21037/tp-24-45. Epub 2024 Aug 28.
Preoperative fear and anxiety are prevalent in children undergoing surgery. The combination of esketamine and dexmedetomidine has been proposed as a promising premedication for enhancing preoperative sedation and analgesia. This study compared the premedication efficacy of intranasal esketamine alone and esketamine-dexmedetomidine combination in pediatric patients undergoing strabismus surgery.
One hundred and eighty preschool children aged 2-6 years scheduled for strabismus surgery were enrolled and randomly assigned to one of the three groups: intranasal premedication with esketamine 2 mg/kg (Group K), esketamine 1 mg/kg and dexmedetomidine 1 µg/kg (Group KD1), or esketamine 0.5 mg/kg and dexmedetomidine 2 µg/kg (Group KD2). The primary outcome was the level of sedation following the intervention, as measured by the modified Yale preoperative anxiety scale (mYPAS) and sedation scale (SS). Secondary outcomes included onset time of sedation, the successful rate of peripheral intravenous cannulation, parental separation anxiety scale (PSAS), mask acceptance scale (MAS), wake-up time, duration of stay in the post-anesthesia care unit (PACU), and premedication-related adverse effects.
After premedication, the mYPAS score gradually decreased in the three groups, with lower values in Group K than in Group KD1 and Group KD2 patients in 1, 5, and 10 min. SS in Group KD1 and Group KD2 steadily increased until 40 min after premedication, while SS in Group K increased in the first 5 min after premedication and maintained consistent levels during the remaining time. Sedation onset was substantially faster in Group K patients (11.4±7.8 min) than Group KD1 (18.1±7.5 min, P=0.006) and Group KD2 (18.4±6.8 min, P<0.001). PSAS, separation status, the successful rate of peripheral intravenous cannulation, and MAS were comparable among groups. There was no significant difference in terms of emergence time or duration of stay in the PACU among groups. More gastrointestinal events were observed in Group K (P<0.001).
Intranasal premedication with 2 mg/kg esketamine produced a more rapid onset of sedation accompanied by more gastrointestinal reactions compared with a combination of esketamine and dexmedetomidine.
ClinicalTrials.gov identifier: NCT04757675.
术前恐惧和焦虑在接受手术的儿童中很常见。艾司氯胺酮和右美托咪定联合使用被认为是一种有前景的术前用药，可增强术前镇静和镇痛效果。本研究比较了单独使用鼻内艾司氯胺酮与艾司氯胺酮 - 右美托咪定联合用药在接受斜视手术的儿科患者中的术前用药效果。
180名计划接受斜视手术的2 - 6岁学龄前儿童被纳入研究，并随机分为三组之一：鼻内给予2 mg/kg艾司氯胺酮进行术前用药（K组）、）、给予1 mg/kg艾司氯胺酮和1 μg/kg右美托咪定（KD1组），或给予0.5 mg/kg艾司氯胺酮和2 μg/kg右美托咪定（KD2组）。主要结局是干预后的镇静水平，通过改良耶鲁术前焦虑量表（mYPAS）和镇静量表（SS）进行测量。次要结局包括镇静起效时间、外周静脉置管成功率、父母分离焦虑量表（PSAS）、面罩接受量表（MAS）、苏醒时间、在麻醉后护理单元（PACU）的停留时间以及术前用药相关的不良反应。
术前用药后，三组的mYPAS评分逐渐降低，K组在1、5和10分钟时的值低于KD1组和KD2组患者。KD1组和KD2组的SS在术前用药后40分钟内稳步增加，而K组的SS在术前用药后的前5分钟增加，并在其余时间保持稳定水平。K组患者的镇静起效时间（11.4±7.8分钟）比KD1组（18.1±7.5分钟，P = 0.006）和KD2组（18.4±6.8分钟，P < 0.001）快得多。PSAS、分离状态、外周静脉置管成功率和MAS在各组之间具有可比性。各组之间在苏醒时间或在PACU的停留时间方面没有显著差异。K组观察到更多的胃肠道事件（P < 0.001）。
与艾司氯胺酮和右美托咪定联合用药相比，鼻内给予2 mg/kg艾司氯胺酮进行术前用药产生的镇静起效更快，但伴有更多的胃肠道反应。
ClinicalTrials.gov标识符：NCT04757675。
