title: Comparison of intranasal dexmedetomidine and dexmedetomidine-ketamine for premedication in pediatrics patients: A randomized double-blind study.
abstract: BACKGROUND
  Goal of premedication in pediatric anesthesia are relieving pre and postoperative anxiety, good parental separation, and smooth induction of anesthesia. Anxiety can produce aggressive reactions, increased distress, increased postoperative pain and postoperative agitation. The benzodiazepine, midazolam, is the most frequently used premedication in pediatric anesthesia. Midazolam has a number of beneficial effects when used as premedication in children: Sedation, fast onset, and limited duration of action. Though midazolam has a number of beneficial effects, it is far from an ideal premedicant having untoward side effects such as paradoxical reaction, respiratory depression, cognitive impairment, amnesia, and restlessness. Dexmedetomidine is a newer α-2-agonist, which can be used as premedicant.
  
  
  OBJECTIVE
  To compare the level of sedation, parental separation, mask acceptance, postoperative recovery of intranasal premedication with dexmedetomidine and dexmedetomidine-ketamine combination in pediatric patients.
  
  
  METHODS
  Prospective randomized double-blind study.
  
  
  METHODS
  After written informed consent from the patient's parents or legal guardian, 54 children of American Society of Anesthesiologists physical status I or II, aged between 1 and 6 years, scheduled to undergo elective minor surgery were enrolled. In group D patient received 1 μg/kg dexmedetomidine intranasally and in group DK received 1 μg/kg dexmedetomidine and 2 mg/kg ketamine intranasally. Patients were assessed every 10 min for the level of sedation, parenteral separation, heart rate, and oxygen saturation by an independent observer. Mask acceptance and postoperative agitation were noted using an appropriate scale.
  
  
  METHODS
  Pearson Chi-square analysis to determine differences between two groups with respect to separation anxiety and acceptance of the anesthesia mask. Percentages used to represent frequencies. The level of significance was set at P< 0.05.
  
  
  RESULTS
  Acceptable parenteral separation was achieved in 90% of patients 30 min after premedication. Sedation was acceptable in 80% of patients at induction. Good mask acceptance was seen in 60% of patients. The incidence of emergence agitation (EA) was 2%. None of the above parameters was statistically significant between the two groups.
  
  
  CONCLUSIONS
  Dexmedetomidine, as premedicant in children provides acceptable parenteral separation. However, mask acceptance in operation room is poor. Combination of dexmedetomidine and ketamine does not increase the success of premedication. Use of dexmedetomidine is associated with decreased EA.
authors.affiliation: Department of Anaesthesiology, SDM College of Medical Sciences, Dharwad, Karnataka, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Bhat
authors.affiliation: Department of Anaesthesiology, SDM College of Medical Sciences, Dharwad, Karnataka, India.
authors.forename: M C B
authors.initials: MC
authors.lastname: Santhosh
authors.affiliation: Department of Paediatric Surgery, SDM College of Medical Sciences, Dharwad, Karnataka, India.
authors.forename: Venkatesh M
authors.initials: VM
authors.lastname: Annigeri
authors.affiliation: Department of Anaesthesiology, SDM College of Medical Sciences, Dharwad, Karnataka, India.
authors.forename: Raghavendra P
authors.initials: RP
authors.lastname: Rao
keywords: Dexmedetomidine; intranasal premedication; ketamine; sedation