Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial.

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Iranian Journal of Medical Sciences Pub Date : 2024-07-01 DOI:10.30476/ijms.2023.99122.3118
Simin Azemati, Maryam Keihani, Mohammad Ali Sahmeddini, Fatemeh Kanaani Nejad, Laleh Dehghanpisheh, Mohammad Bagher Khosravi, Naeimehossadat Asmarian
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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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比较右美托咪定、咪达唑仑和氯胺酮在门诊儿科手术中的镇静效果:随机临床试验。
背景:如何处理小儿患者的术前焦虑及其影响一直是麻醉医生面临的挑战。在这项研究中,我们比较了鼻内注射右美托咪定、咪达唑仑和氯胺酮作为儿童手术术前用药的安全性和有效性:这项双盲随机临床试验于 2014 年 1 月在两家三甲医院进行,共有 90 名 2-7 岁的儿童参加。参与者的美国麻醉医师协会(ASA)身体状况为I级或II级,计划进行择期单侧腹股沟疝成形术。采用区组随机法将患者随机分配到三组,每组在麻醉诱导前 60 分钟分别接受右美托咪定(2 µg/Kg)、咪达唑仑(0.2 mg/Kg)和氯胺酮(8 mg/Kg)的鼻内注射。在给药前评估焦虑和镇静状态,然后在接下来的 50 分钟内每隔 10 分钟评估一次。此外,还记录了父母的分离焦虑、面罩接受度、术后躁动、疼痛、恶心和呕吐情况,并在这些组别之间进行了比较。所有统计分析均使用 SPSS 软件(21.0 版)进行。结果氯胺酮在用药前 10 分钟、20 分钟和 30 分钟后的镇静效果最强(结论:氯胺酮在用药前 10 分钟、20 分钟和 30 分钟后的镇静效果最强:在紧急情况下,鼻内氯胺酮的作用时间最短。在本研究中,右美托咪定是药效最强的药物,可在儿科择期手术前 40-50 分钟使用。
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来源期刊
Iranian Journal of Medical Sciences
Iranian Journal of Medical Sciences MEDICINE, GENERAL & INTERNAL-
CiteScore
3.20
自引率
0.00%
发文量
84
审稿时长
12 weeks
期刊介绍: The Iranian Journal of Medical Sciences (IJMS) is an international quarterly biomedical publication, which is sponsored by Shiraz University of Medical Sciences. The IJMS intends to provide a scientific medium of com­muni­cation for researchers throughout the globe. The journal welcomes original clinical articles as well as clinically oriented basic science re­search experiences on prevalent diseases in the region and analysis of various regional problems.
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