A Comparison of Intranasal Dexmedetomidine and Dexmedetomidine-Ketamine Combination Sedation for Transthoracic Echocardiography in Pediatric Patients With Congenital Heart Disease: A Randomized Controlled Trial

Objectives: To compare the effects of intranasal dexmedetomidine (DEX) and DEX-ketamine (KET) on hemodynamics and sedation quality in children with congenital heart disease. Design: A randomized controlled, double-blind, prospective trial. Setting: A tertiary care teaching hospital. Participants: The study comprised 60 children undergoing transthoracic echocardiography (TTE). Interventions: Patients were randomly allocated into the DEX group (group D [n = 30]) or the DEX-KET group (group D-K [n = 30]). Group D received 2 mg/kg of intranasal DEX; group D-K received 2 mg/kg of DEX and 1 mg/kg of KET intranasally. Measurements and Main Results: The primary outcome was the change in hemodynamics, measured using mean arterial pressure (MAP) and heart rate (HR). Secondary outcomes were onset time, wake-up time, and discharge time. No differences were found in mean arterial pressure or heart rate. The onset time was significantly shorter in group D-K than in group D (9.6 +/- 2.9 minutes v 14.3 +/- 3.4 minutes; p = 0.031). The wake-up time was longer in group D-K than in group D (52 +/- 14.7 minutes v 39.6 +/- 12.1 minutes; p = 0.017). The discharge time was longer in group D-K than in group D (61.33 +/- 11.59 minutes v 48.17 +/- 8.86 minutes; p < 0.001). No differences in hemodynamics were found between the 2 groups. Intranasal DEX was found to be as effective for TTE sedation as intranasal DEX-KET, with longer onset time and shorter recovery and discharge times. Conclusion: No differences in hemodynamics were found between the 2 groups. Intranasal DEX was found to be as effective for TTE sedation as is intranasal DEX-KET, with longer onset time and shorter recovery and discharge times. (C) 2020 Elsevier Inc. All rights reserved.