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


Eligible participants were recruited in the study from April 2014 to June 2014. Eleven patients were excluded after randomization because of premedication failure (3, 4, and 4 patients in groups D, DK, and K, respectively). A total of 124 patients were included in the final statistical analyses (Figure 1). Sex, age, weight, surgical diagnosis, duration of operation were similar among groups (Table 2).

Figure 1.

Consort flow diagram

The rate of successful venous cannulation was significantly higher in group DK and group K than in group D (P = 0.006), whereas the rate of satisfactory separation did not differ significantly among groups (P = 0.078) (Table 3). Sedation scores of the three groups showed no significant difference at T10; however, they were significantly lower in group D and group DK than in group K at T20 and T30 (P < 0.001) (Table 4). The time of sedation onset in group DK and group D was significantly shorter than in group K (P = 0.001). The time of LMA removal exhibited no significant difference among groups (P = 0.112). By contrast, the time of resumption of mental orientation was significantly different among groups (P = 0.001) (Table 3).

HR became gradually slower after premedication in group D and group DK; the HRs in group D and group DK were significantly lower than in group K at T20 and T30 (P = 0.005) (Table 5). SpO2 was stable and similar before transfer to the operating room in all groups. Five children treated with ketamine alone appeared to experience upper airway irritation during induction, which improved after intravenous injection of 1.0 mg/kg succinylcholine. No child in group D or group DK experienced respiratory complications during induction.

The rates of vomiting, salivation, psychological/psychiatric adverse events, and respiratory adverse events were significantly increased in group K during the recovery period and the first 24 h after surgery. Hypoxia occurred in three patients because of irritation from secretions during removal of the LMA. In one patient, choking and breath-holding were observed, and the LMA was reinserted after deepening the level of anesthesia. Children in group D and group DK experienced fewer postoperative adverse events overall (P = 0.0152) than those in group K (Table 6).