Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

Jul 24, 2018British journal of anaesthesia

Comparing inhaled dexmedetomidine, ketamine, and midazolam as premedication for young children having bone marrow biopsies

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Abstract

The median sedation score on arrival in the operating room was 3.5 for midazolam, compared to 2.0 for both dexmedetomidine and ketamine.

Dexmedetomidine resulted in higher medication and mask acceptance scores compared to ketamine and midazolam.
Parents reported lower separation anxiety when children were premedicated with dexmedetomidine.
The recovery time was significantly shorter for dexmedetomidine (5.5 minutes) than for ketamine (10.0 minutes) and midazolam (8.0 minutes).
Emergence agitation was less common in children premedicated with dexmedetomidine.

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BACKGROUND: The aim of our study was to compare the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication administered by nebuliser 30 min before general anaesthesia in preschool children undergoing bone marrow biopsy and aspiration.

METHODS: Ninety children aged 3-7 yr were randomly allocated into three equal groups to be premedicated with either nebulised ketamine 2 mg kg(Group K), dexmedetomidine 2 μg kg(Group D), or midazolam 0.2 mg kg(Group M). The primary endpoint was a five-point sedation score on arrival in the operating room 30 min after end of study drug administration. Secondary outcomes included: parental separation anxiety scale; medication and mask acceptance scales; haemodynamic variables; recovery time; postoperative face, legs, activity, cry, and consolability scale; emergence agitation scale; and adverse effects. -1 -1 -1

RESULTS: The median (range) sedation score on arrival in the operating room was 3.5 (1-4), 2.0 (2-3) and 2.0 (1-3) in Groups M, D, and K, respectively (P=0.000). Subjects in Group D showed higher medication (P<0.03) and mask acceptance scores (P<0.015) and more satisfactory parental separation anxiety scale (P<0.044). The median (range) recovery time was significantly shorter in Group D [5.5 (4-8) min] compared with Group K [10.0 (5-15) min, P=0.000] and M [8.0 (6-15) min, P=0.000]. The incidence of emergence agitation was lower in Group D (P<0.008).

CONCLUSIONS: Preschool children premedicated with nebulised dexmedetomidine had more satisfactory sedation, shorter recovery time, and less postoperative agitation than those who received nebulised ketamine or midazolam.

CLINICAL TRIAL REGISTRATION: NCT02935959.

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Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

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