Comparison of different dosage combinations of intranasal dexmedetomidine and ketamine used for procedural sedation in pediatric patients undergoing minor surgeries in day care setup

Background: Procedural sedation of pediatric patients is necessary to minimize physical pain and psychological trauma and return the patients safely to their parents. Although ketamine and dexmedetomidine have been studied separately for minor surgical procedures, an ideal combination of doses of these two drugs through the intranasal route remains unclear. Aims and Objectives: The aim of the study was to compare the different dosage combinations of intranasal dexmedetomidine and intranasal ketamine that can be utilized for procedural sedation in pediatric patients undergoing surgeries in a day care setup to find a suitable dose combination for future use. The objectives of the study were to determine the degree of sedation at the time separation from the parents along with hemodynamic changes after drug instillation. Materials and Methods: A total of 60 pediatric patients scheduled for day care surgeries were randomized into two groups. Group DK1 received intranasal dexmedetomidine 1 mcg/kg combined with ketamine 5 mg/kg, whereas Group DK2 received intranasal dexmedetomidine 1 mcg/kg with ketamine 7 mg/kg. Sedation level and parental separation were assessed 30 min after drug administration using the parental separation anxiety scale (PSAS) and Ramsay sedation score. Results: The DK2 group had significantly better parental separation with a mean PSAS score of 1.6 compared to 2.6 in Group DK1 (P<0.001). Adequate sedation as assessed by Ramsay sedation score was achieved in 13 patients (43%) in DK1 and 22 patients (73%) in DK2. Conclusion: The study observed that dexmedetomidine with the higher dose of ketamine, in the pediatric age group, decreases the parental separation anxiety without serious clinical side effects.