Comparative Study of Nebulized Dexmedetomidine and Intramuscular Ketamine for Premedication in Paediatric Patients Undergoing Hernia Repair Surgery

Abstract Background Infants and preschool children that require surgery and imaging are often anxious, due to the separation from their parents, fear of doctors, and unfamiliar environments, and it is often difficult to obtain their cooperation. Aim of the Work It was to determine the sedative effect of inhaled nebulized dexmedetomidine as a premedication for pediatrics compared to intramuscular ketamine. Patients and Methods 60 patients, aged 2 to 8 years of both sexes scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (5 mg/kg) before the induction of anesthesia. Results Sedation scale (RSS) was significantly lower in Dexmedetomidine group than in Ketamine group at minutes-5, 10 and 15. Acceptable sedation was significantly less frequent in Dexmedetomidine group than in Ketamine group at minutes-5, 10 and 15. Dexmedetomidine group significantly had more frequent excellent parental separation anxiety and less frequent fair parental separation anxiety than Ketamine group had. Acceptable parental separation was significantly more frequent in Dexmedetomidine group than in Ketamine group. Dexmedetomidine group significantly had more frequent excellent mask acceptance and less frequent fair mask acceptance than Ketamine group had. Satisfactory mask acceptance was significantly more frequent in Dexmedetomidine group than in Ketamine group. Recovery time was significantly shorter in Dexmedetomidine group than in Ketamine group. Watcha score was higher in Dexmedetomidine group than in Ketamine group beginning from minute-0 until minute-30, but the differences were statistically significant only at minutes-25 and 30. Emergence agitation (Watcha-3/4) started to appear in Dexmedetomidine group at minute-20 and its frequency increased until minute-30, while in Ketamine group Emergence agitation (Watcha-3/4) appeared at minute-30. Emergence agitation (Watcha-3/4) was more frequent in Dexmedetomidine group than in Ketamine group in minutes-20, 25 and 30, but the differences were statistically significant only at minutes-25 and 30. Bradycardia and hypotension were more frequent in Dexmedetomidine group, but the differences were statistically significant only in case of bradycardia. Conclusion Dexmedetomidine nebulization had better smooth separation from parents and had satisfactory acceptance of face mask for induction of general anesthesia compared to intramuscular ketamine. Sedation was the same between the two groups. Emergence agitation was higher in Dexmedetomidine group.