A randomised study of intranasal dexmedetomidine and oral ketamine for premedication in children

We studied the effects of intranasal dexmedetomidine combined with oral ketamine for premedication in children. One hundred and sixty children aged between 2 and 6years were randomly allocated to one of four groups: 1g.kg(-1) intranasal dexmedetomidine with 3mg.kg(-1) oral ketamine (Group 1); 1g.kg(-1) intranasal dexmedetomidine with 5mg.kg(-1) oral ketamine (Group 2); 2g.kg(-1) intranasal dexmedetomidine with 3mg.kg(-1) oral ketamine (Group 3); and 2g.kg(-1) intranasal dexmedetomidine with 5mg.kg(-1) oral ketamine (Group 4). Sedation levels 10, 20 and 30min after premedication were evaluated using a 5-point sedation scale. A 4-point emotional state score was used to evaluate patients when they were separated from their parents and their response to intravenous cannulation or facemask application. Approximately 90% of patients readily accepted premedication and onset times of acceptable sedation were similar in all four groups. Patients in Group 4 were significantly more sedated than those in Group 1 after 30 min (p=0.036). A significantly higher proportion of patients in Group 3 (84%) and Group 4 (87%) accepted intravenous cannulation compared with those in Group 1 (40%) and Group 2 (54%) (p=0.001). We conclude that the administration of 2g.kg(-1) intranasal dexmedetomidine and 3mg.kg(-1) oral ketamine was the optimal combination, with children being easily separated from their parent, accepting intravenous cannulation and without causing excessive side-effects or postoperative complications.