Pediatric Premedication: A Double-blind Randomized Trial of Dexmedetomidine or Ketamine Alone Versus a Combination of Dexmedetomidine and Ketamine

Hui Qiao; Zhi Xie; Jie Jia


BMC Anesthesiol. 2017;17(158) 

In This Article


For pediatric patients undergoing general anesthesia, personality and behavior in the early postoperative period tend to be adversely affected if patients fail to cooperate before the induction of anesthesia.[1] Appropriate preoperative communication, being accompanied by their parents during anesthesia induction, medication interventions, and other methods are commonly used to lessen preoperative nervousness and anxiety in children. Medication interventions are widely used in clinical practice, and ideal premedication attributes include prompt onset of action, short duration, simple route of administration that is readily accepted by children, minimal side effects, reliable pain relief, and regulation of autonomic responses.[2] To date, there remains no widely-accepted premedication regimen.

Dexmedetomidine is an alpha 2-adrenoreceptor agonist that provides sedation, analgesia, and anxiolysis without respiratory depression in clinical practice. Its colorless and odorless properties make dexmedetomidine suitable for intranasal administration. Preoperative intranasal instillation of 1–2 μg/kg dexmedetomidine has been reported to produce sedation and ameliorate separation anxiety.[3,4]

Oral ketamine is commonly used as a premedication for pediatric patients. Oral administration of ketamine is characterized by a high first-pass elimination effect and potential undesirable postoperative side effects, including salivation, delirium, and anxiety.[5]

Dexmedetomidine and ketamine exhibit complementary pharmacological effects. Dexmedetomidine reduces cardiovascular responses and postoperative psychiatric adverse reactions attributed to anesthesia induction with ketamine.[6] We conducted the current study to investigate whether the combination of dexmedetomidine and a low dose of ketamine in pediatric patients improved cooperation during invasive procedures (intravenous cannulation) and alleviated preoperative anxiety, while producing minimal adverse events.