Jul 2026· Aposta: Revista de Ciencias Sociales· Vol 24, pp. e1350· 0 citations· 17 references
TL;DR
Intranasal dexmedetomidine appears to be the preferred premedication for facilitating smooth anesthetic induction in pediatric patients undergoing elective surgery while maintaining comparable hemodynamic stability and induction time.
Abstract
Background: Preoperative anxiety in children undergoing surgery can complicate anesthetic induction and adversely affect perioperative outcomes. Intranasal administration of premedication is a non-invasive route that provides rapid drug absorption and good patient compliance. This study compared the efficacy of intranasal ketamine and intranasal dexmedetomidine as premedication in pediatric patients undergoing elective surgery. Methods: This double-blind randomized controlled trial was conducted at the Department of Anesthesia, Children's Hospital Lahore, from January 2026 to May 2026. A total of 134 children aged 2–6 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective ENT surgery were randomly assigned to receive either intranasal ketamine (5 mg/kg; Group K, n = 67) or intranasal dexmedetomidine (1 μg/kg; Group D, n = 67). The primary outcome was effective mask acceptance, defined as a Mask Acceptance Score (MAS) ≤2 during anesthetic induction. Secondary outcomes included hemodynamic parameters, induction time, and adverse events, including coughing, sneezing, and postoperative nausea and vomiting (PONV). Results: Baseline demographic and clinical characteristics were comparable between the groups. Effective mask acceptance (MAS ≤2) was achieved in 85.1% of children receiving dexmedetomidine compared with 67.2% receiving ketamine (p < 0.05). Poor mask acceptance (MAS = 3) occurred more frequently in the ketamine group (32.8%) than in the dexmedetomidine group (14.9%). Heart rate, oxygen saturation, and induction time did not differ significantly between groups (p > 0.05). The incidence of postoperative nausea and vomiting was higher in the ketamine group (25.4%) than in the dexmedetomidine group (10.4%), although the difference was not statistically significant. Similarly, coughing and sneezing were more frequent with ketamine, but not statistically significant. Conclusion: Intranasal dexmedetomidine provided significantly better mask acceptance than intranasal ketamine while maintaining comparable hemodynamic stability and induction time. Although adverse events were numerically fewer with dexmedetomidine, these differences were not statistically significant. Intranasal dexmedetomidine appears to be the preferred premedication for facilitating smooth anesthetic induction in pediatric patients undergoing elective surgery.
Ketamine-dexmedetomidine as a preferred oral premedication option in pediatric patients undergoing elective surgery support ketamine-dexmedetomidine as a preferred oral premedication option in Pediatrics.
Neha D Pokar, Sarika Dhaduk· International Journal of Sci...· 0 citations
S-ketamine provides superior analgesia and reduces intraoperative opioid requirements without compromising sedation or anxiolysis, suggesting it may be a preferable option in this population of children undergoing tonsillectomy.
Ivana Fajertag, Vlado Janković, Maja Sujica et al.· Serbian Journal of Anesthesi...· 0 citations
Pediatric magnetic resonance imaging (MRI) requires deep sedation to ensure immobility and optimal image quality. Propofol-based total intravenous anesthesia is effective but may cause airway depression and hemodynamic instability at higher doses. Dexmedetomidine has minimal respiratory effects but may prolong sedation. This study evaluated whether a low-dose dexmedetomidine bolus combined with propofol shortens recovery time (primary outcome); improves hemodynamic stability; reduces airway events, induction time, and total propofol dose; and minimizes scan interruptions (secondary outcomes).
In this prospective, randomized controlled trial, children undergoing MRI were assigned to two groups. Group D+P received 0.5 μg/kg of dexmedetomidine over 2–3 minutes plus a 1 mg/kg bolus of propofol followed by infusion; Group P received propofol alone as bolus and infusion. Propofol infusion rate was adjusted to achieve a Ramsay Sedation Scale score of 5–6. Recovery time was analyzed using
t
test; scan interruptions were compared using Chi-square or Fisher’s exact tests.
Group D+P had a shorter recovery time (19.4 ± 35 vs. 31.4 ± 36.1 min;
P
= 0.042) and faster induction (128.9 vs. 224.6 sec;
P
< 0.001). The propofol infusion rate was lower in Group D + P than in Group P (76.3 ± 65.6 vs 123 ± 45.5 μg/kg/min;
P
< 0.001). Additional boluses were more frequent in Group P (
P
= 0.003). Bradycardia occurred in significantly more children in Group D + P than in Group P (
P
= 0.008).
Low-dose dexmedetomidine as an adjunct to propofol for pediatric MRI sedation reduces recovery time, propofol requirement, and airway-related complications, while enabling faster induction and fewer scan interruptions with increased risk of bradycardia.
Kishorkumar Dhanaboopathy, E. Rai, Aparna Williams et al.· Journal of Anaesthesiology C...· 0 citations
BACKGROUND
Adequate sedation during spinal anesthesia requires careful titration to avoid hemodynamic instability and respiratory complications. We hypothesized that intrathecal fentanyl, used as an adjunct to neuraxial anesthesia, would reduce dexmedetomidine requirements for conscious sedation. This study evaluated the effects of intrathecal fentanyl on the total dose of dexmedetomidine during spinal anesthesia.
METHODS
Sixty-four patients undergoing knee or ankle arthroscopy under spinal anesthesia were randomly assigned to two groups. The fentanyl group received 0.5% bupivacaine 10 mg with fentanyl 20 μg, whereas the control group received bupivacaine 10 mg with saline. After confirmation of sensory block, dexmedetomidine was infused at 1 μg/kg over 10 minutes and maintained at 0.1-1 μg/kg/hour to maintain a bispectral index (BIS) of 70 to 80. The primary outcome was the total dose of dexmedetomidine. Secondary outcomes included BIS values, Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores, mean blood pressure, and heart rate at predefined time points.
RESULTS
The total dose of dexmedetomidine did not differ significantly between the groups. The MOAA/S scores were significantly affected by group, time, and group-by-time interactions (p=0.003, p<0.001, and p=0.007, respectively). The BIS values were influenced by group (p=0.026) and time (p<0.001), but not by group-by-time interactions (p=0.413). Exploratory analyses suggested deeper sedation in the fentanyl group during the early phase of dexmedetomidine infusion. Hemodynamic variables were comparable between the groups.
CONCLUSION
Intrathecal fentanyl did not significantly reduce dexmedetomidine requirements during spinal anesthesia, although it was associated with deeper sedation at several time points.
K. B. Park, J. Yeom, Juhee Min et al.· Journal of Yeungnam Medical...· 0 citations
Background: Spinal anesthesia is a very commonly used procedure in modern-day anesthesia practice. Today most of the lower limb surgeries are performed under spinal anesthesia. Midazolam, dexmedetomidine, and fentanyl are common intravenous adjuvants used during anesthesia to allay anxiety and sedation. The aim of this study was to compare the effects of intravenous dexmedetomidine-midazolam versus fentanyl-midazolam in terms of analgesic characteristics, sedation, and adverse effects.
Methods: This is a randomized prospective study that included 35 patients in each group, posted for lower limb orthopedic surgery. Intravenous dexmedetomidine, fentanyl, and midazolam were administered after subarachnoid block. Data for sedation, analgesia, hemodynamic parameters, and adverse effects were recorded.
Results: RR for FM group showed significant intra-group variability in RR across perioperative stages (p<0.05), whereas the DM group maintained greater respiratory stability (p=0.243). HR for DM group exhibited significantly lower intraoperative and postoperative HR compared to FM group (p<0.001), with notable within-group changes, unlike the FM group. MAP for both groups remained stable over time (DM: p= 0.283, FM: p= 0.260), although the FM group had slightly higher values in the postoperative recovery phase. Sedation (RSS): DM produced deeper and more sustained sedation intraoperatively and postoperatively (p<0.001), while FM showed quicker sedation decline. Patient satisfaction was significantly higher in the DM group (VAS: 3.0 vs. 4.0, p= 0.001), although surgeon satisfaction did not differ notably. Adverse events were rare and comparable, though hypotension was more frequent in the DM group (22.9% vs. 8.6%).
Conclusion: Dexmedetomidine plus midazolam provided superior sedation quality and patient satisfaction, with more stable cardiopulmonary parameters during orthopedic surgery under spinal anesthesia. Despite a slightly higher rate of hypotension, DM appears to offer a more favorable sedative profile compared to fentanyl plus midazolam.
M. Rahimi, Mohamad Sorani, Afzal Shamsi et al.· Archives of Anesthesia and C...· 0 citations
Background Awake percutaneous endoscopic lumbar discectomy (PELD) preserves intraoperative patient feedback, but local infiltration anesthesia may inadequately control pain and anxiety during deeper procedural stages. Intranasal dexmedetomidine offers a noninvasive adjunct, although evidence in this setting remains limited. Methods This two-center retrospective cohort study included 135 adults undergoing PELD with local infiltration anesthesia alone (n=80) or adjunctive intranasal dexmedetomidine (n=55). Pain and anxiety were assessed using the VAS and HADS-A, respectively. VAS scores were analyzed using a linear mixed model adjusted for study center and prespecified covariates. HADS-A scores were analyzed using ANCOVA adjusted for center, baseline HADS-A, and the same patient-level covariates. Results After adjustment for center and prespecified baseline covariates, recorded pain was lower in the intranasal dexmedetomidine group at puncture, channel establishment, annular incision or nucleus removal, and the end of surgery. The largest adjusted difference occurred during annular incision or nucleus removal (mean difference, −1.81; 95% CI, −2.09 to −1.54; Holm-adjusted P<0.001). Rescue analgesia was recorded in 4 of 55 patients (7.3%) versus 18 of 80 (22.5%). Any adverse event was documented in 5 of 55 patients (9.1%) versus 8 of 80 (10.0%). Conclusion In this retrospective cohort, intranasal dexmedetomidine was associated with lower recorded procedural pain and anxiety, lower hemodynamic peaks, and less frequent rescue analgesia. The observational design precludes causal inference and cannot establish safety regarding uncommon events. Prospective randomized evaluation is warranted.
Yonghong Zhou, Chao Pan, Yan Jiang et al.· Journal of Pain Research· 0 citations
