A comparative evaluation of analgo‐sedative effects of oral dexmedetomidine and ketamine: a triple‐blind, randomized study

Paediatric Anaesthesia - Tập 24 Số 12 - Trang 1252-1259 - 2014
Charanjeet Singh1, Ramesh Kumar Pandey1, Anil K. Saksena2, Girish Chandra3
1Department of Pediatric and Preventive Dentistry, King George's Medical University, Lucknow, India
2Department of Pharmacology, King George’s Medical University, Lucknow, India
3Department of Anesthesia, King George’s Medical University, Lucknow, India

Tóm tắt

SummaryBackgroundUse of sedative agents for difficult to manage children during dental procedures has been indicated for years, but neither the agent nor the route has been found to be ideal.ObjectivesThe aim of the study was to evaluate and compare the efficacy and safety of oral dexmedetomidine (D) and ketamine (K) in producing moderate sedation among uncooperative pediatric dental patients.MethodsThis prospective, triple‐blind, randomized comparative study included 112 ASA grade I children of both sexes aged 3–10 years, who satisfied all the inclusion criteria. They were randomly divided into four groups and ketamine 8 mg·kg−1 (K) or dexmedetomidine 3 μg·kg−1 (D1), 4 μg·kg−1 (D2) and 5 μg·kg−1 (D3) were given orally. Similar dental procedures were performed in these patients, and effects of these drugs were assessed in terms of changes in vital signs, onset and duration of sedation, analgesia, and amnesia. Secondary outcomes such as level of sedation, behavior, adverse effects, and overall success were also measured.ResultsThe onset of sedation was significantly rapid with K and D3 as compared to D1 and D2. Recovery from sedation was fastest in group D1. Intra‐ and postoperative analgesia and anterograde amnesia were highest with K and least with D1, while D3 produced analgesia comparable to K. In K treated group, vomiting was observed in five patients and two patients exhibited emergence phenomenon. Overall, highest success rate was observed in D3 group.ConclusionsGiven by oral route, the novel sedative dexmedetomidine provides dose‐dependent effective analgo‐sedation, comparable to ketamine, with less adverse effects.

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Tài liệu tham khảo

10.14219/jada.archive.2003.0326

American Academy of Pediatrics, American Academy of Pediatric Dentistry, 2011, Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures, Pediatr Dent, 33, 185

HallonstenAL JensenB RaadalMet al.EAPD Guidelines on Sedation in Paediatric Dentistry2003http://www.eapd.gr/dat/5CF03741/file.pdf

10.1111/j.1365-2044.2007.05298.x

Goodman LS, 1996, Goodman & Gilman's the Pharmacological Basis of Therapeutics, 538

10.1046/j.1365-2044.1999.01114.x

Alfonzo‐Echeverri EC, 1993, Oral ketamine for pediatric outpatient dental surgery sedation, Pediatr Dent, 15, 182

Reinemer HC, 1996, A comparison of two oral ketamine‐diazepam regimens for sedating anxious pediatric dental patients, Pediatr Dent, 18, 294

Bui T, 2002, A comparison study between ketamine and ketamine‐promethazine combination for oral sedation in pediatric dental patients, Anesth Prog, 49, 14

10.1097/00000542-199201000-00004

10.1046/j.1365-2346.1996.00058.x

10.1097/00003643-200301000-00010

10.1111/j.1460-9592.2005.01623.x

10.1016/j.jclinane.2008.03.004

10.17796/jcpd.34.2.cgn410227k80751l

10.17796/jcpd.35.4.l43h3354705u2574

10.1111/j.1460-9592.2007.02218.x

10.1093/bja/aei040

Murphy MG, 1984, Parental acceptance of pediatric dentistry behavior management techniques, Pediatr Dent, 6, 193

10.1007/BF03262654

10.1097/00005176-199709000-00004

Flaiz CM, 1985, Evaluation of the sedative effect of rectally administered diazepam for the young dental patients, Pediatr Dent, 7, 292

Malamed SF, 2010, Sedation. A Guide to Patient Management

10.1111/j.1460-9592.2007.02332.x

10.1046/j.1365-2125.2003.01944.x

Tobias JD, 1992, Oral ketamine premedication to alleviate the distress of invasive procedures in pediatric oncology patients, Pediatrics, 90, 537, 10.1542/peds.90.4.537

10.1093/bja/aei119

10.1213/01.ane.0000269488.06546.7c

10.1016/0304-3959(94)00123-V

10.1097/00000539-199602000-00001

10.1097/00000542-200009000-00016

10.1111/j.1365-2044.2007.05230.x

10.1093/bja/53.8.805

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Paediatric Anaesthesia

Tập 24 Số 12

1252-1259

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