Comparative Evaluation of Oral Ketamine-Dexmedetomidine Versus Oral Ketamine-Midazolam as Premedication in Pediatric Patients Undergoing Elective Surgery Under Anaesthesia
Jul 2026· International Journal of Science and Research (IJSR)· 0 citations· 7 references
TL;DR
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.
Abstract
: Background: Preoperative anxiety is a significant challenge in pediatric anaesthesia, necessitating effective premedication strategies. Oral drug combinations offer a non-invasive and child-friendly approach to achieving adequate sedation and anxiolysis. This study evaluates two commonly employed oral premedication regimens-ketamine combined with dexmedetomidine (KD) and ketamine combined with midazolam (KM) — in children aged 2 – 10 years scheduled for elective procedures. Methods: A prospective observational study was conducted at a tertiary care hospital over 14 months (March 2024 – May 2025). Sixty pediatric patients (ASA I – III, aged 2 – 10 years) were allocated into two groups of 30 each. Group KM received oral ketamine 3 mg/kg + midazolam 0.3 mg/kg, and Group KD received oral ketamine 3 mg/kg + dexmedetomidine 3 mcg/kg, each diluted in mango juice and administered 50 minutes before surgery. Sedation was assessed using the Modified Observer's Assessment of Alertness/Sedation (MOAAS) scale, parental separation anxiety score, mask acceptance scale, and hemodynamic parameters. Results: At the 50-minute time point, Group KD showed significantly deeper sedation (MOAAS: 2.1 ± 0.64) compared to Group KM (2.6 ± 0.60; p < 0.05). Parental separation was rated excellent in 90% of KD patients versus 56.7% in KM (p < 0.001). Mask acceptance was superior in KD (83.3% excellent) compared to KM (46.7% excellent; p = 0.006). Hemodynamic parameters remained clinically stable in both groups with no significant intergroup differences. No adverse events were recorded in either group. Conclusion: Both premedication regimens demonstrated acceptable sedative profiles; however, the ketamine-dexmedetomidine combination provided superior sedation depth, smoother parental separation, and better mask acceptance with a comparable safety profile. These findings support ketamine-dexmedetomidine as a preferred oral premedication option in pediatric patients undergoing elective surgery.
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
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation and analgesia. Ketamine–propofol and ketamine–midazolam is commonly used, but comparative data in ERCP are limited.
Objective: To compare the effectiveness and safety of ketamine–propofol (KP) versus ketamine–midazolam (KM) for procedural sedation during ERCP.
Methods: This prospective observational study included 50 ASA I–II patients aged 18–70 years undergoing ERCP, equally allocated to two groups. The KP group received ketamine–propofol 1:1 (0.5 mg/kg loading dose, 2–3 mg/kg/h infusion). The KM group received ketamine 0.5 mg/kg plus midazolam 0.02 mg/kg, with supplemental doses as required. Sedation was targeted to a Ramsay score of 5. Time to achieve targeted Ramsey Sedation Score after induction, patient needing rescue sedation, hemodynamic variables, recovery time, and adverse events were recorded. Data were analyzed using t-tests and chi-square tests, with P < 0.05 considered significant.
Results: Group KP achieved faster sedation than Group KM (184.80 ± 48.74 vs. 314.40 ± 92.11 seconds; P value < 0.001) and shorter recovery time (7.92 ± 1.89 vs. 9.48 ± 2.25 min; P value < 0.05). Discharge time was similar between groups. Hemodynamic parameters were lower in the KP group after induction. Desaturation and airway maneuvers were more frequent with KP while post procedure nausea and vomiting and recovery agitation were more common with KM group, though not statistically significant.
Conclusion: Both regimens were effective for ERCP sedation. Ketamine–propofol provided faster onset, quicker recovery and better hemodynamic control, but with more respiratory adverse events.
Bibek Shrestha, Samir Shakya, Jeevan Singh et al.· Nepal Journal of Medical Sci...· 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:Emergence agitation (EA) is a common and distressing complication following sevoflurane anaesthesia in paediatric patients, characterized by non-purposeful restlessness, crying, and disorientation. Dexmedetomidine, a highly selective α2-agonist, is frequently utilized to prevent EA. However, the optimal administration method, rapid intravenous bolus versus continuous intraoperative infusion, remains debated regarding the balance of efficacy and hemodynamic stability.Aims and Objectives:To systematically compare the clinical effectiveness, postoperative recovery profile, and perioperative hemodynamic stability of a rapid bolus versus a continuous low-dose infusion of dexmedetomidine (0.3 μg/kg) in preventing emergence agitation in children undergoing elective abdominal and genitourinary surgeries under sevoflurane anaesthesia.Materials and Methods:This prospective, randomized, double-blind, comparative study enrolled 80 paediatric patients (ASA physical status I–II, aged 2–12 years) randomly allocated into two equal groups (n=40). Group B received IV dexmedetomidine 0.3 μg/kg as a bolus over 10 minutes; Group I received a continuous infusion at 0.3 μg/kg/hour. Intraoperative Heart Rate and MAP were continuously monitored. Postoperative emergence agitation and pain were assessed using the PAED scale and Observational Pain Scores (OPS) in the PACU.Results:Both techniques provided comparable hemodynamic stability. A transient, statistically significant decrease in MAP (p=0.015) was noted at 10 minutes post dexmedetomidine administration in group B, accompanied by a mild, non significant reduction in heart rate (p=0.184); all values remained within 20% of pre-induction baselines without requiring intervention. Group B demonstrated superior early analgesia (OPSon PACU arrival: 1.8 ± 1.2 vs 4.6 ± 1.8; p<0.001). Extubation times (6.2 ± 1.1 vs 6.5 ± 1.4 min; p=0.284) and emergence times (8.1 ± 1.5 vs 8.4 ± 1.8 min; p=0.418) were highly comparable.Conclusion:A 0.3 μg/kg bolus of dexmedetomidine is hemodynamicallysafe and clinically superior to an equivalent continuous infusion. It provides good early postoperative analgesia and effectively mitigates sevoflurane-induced emergence agitation without extending recovery or extubation times.
Sardar Bhagat Singh, Manmohan Jindal, Namrata Jain et al.· Asian Journal of Medical Res...· 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
Ultrasound-guided supraclavicular brachial plexus block is widely used for anaesthesia and postoperative analgesia in upper-limb surgery. Although bupivacaine provides prolonged regional anaesthesia, its duration may be insufficient for postoperative pain control. Adjuvants such as ketamine and dexamethasone have therefore been used to improve block characteristics and prolong analgesia. Objective: To compare ketamine and dexamethasone as adjuvants to bupivacaine for ultrasound-guided supraclavicular brachial plexus block in patients undergoing upper-limb surgery. Methods: This double-blind randomized controlled trial was conducted in the Department of Anesthesiology, Aziz Bhatti Shaheed Teaching Hospital, Gujrat from June to December 2025. Sixty patients aged 18–60 years with ASA physical status I or II undergoing elective upper-limb surgery were randomized into two equal groups. Group K received bupivacaine with 50 mg ketamine, while Group D received bupivacaine with 8 mg dexamethasone. Sensory and motor block onset and duration, postoperative analgesia, haemodynamic stability, and adverse events were compared between the groups. Results: Baseline characteristics were comparable between the groups. Sensory block onset was significantly faster with dexamethasone than ketamine (13.5 ± 3.8 vs. 16.8 ± 4.5 minutes; P=0.003), as was motor block onset (15.8 ± 4.2 vs. 19.2 ± 5.1 minutes; P=0.006). Dexamethasone significantly prolonged sensory block duration (760.5 ± 105.2 vs. 415.3 ± 85.6 minutes), motor block duration (705.4 ± 98.1 vs. 370.2 ± 75.4 minutes), and postoperative analgesia (752.5 ± 110.5 vs. 382.6 ± 88.4 minutes; all P<0.001). Haemodynamic parameters remained stable in both groups, and no major adverse events were observed. Conclusion: Dexamethasone was more effective than ketamine as an adjuvant to bupivacaine for ultrasound-guided supraclavicular block, providing faster block onset and substantially longer sensory block, motor block, and postoperative analgesia without major adverse effects.
Ahad Ali Khan, Hafiz Muhammad Usama Javed, Muhammad Ahmad et al.· Biological and Clinical Scie...· 0 citations
