2018, Vol. 1, Issue 2, Part A

Background and Objective: Preoperative anxiety and separation from parents remain persistent challenges for anesthesiologists managing pediatric patients. Dexmedetomidine (DexM), a selective ?2-adrenoceptor agonist, exerts sedative and analgesic effects through central nervous system (CNS) pathways. Ketamine (KET), an N-methyl-D-aspartate (NMDA) receptor antagonist, induces sedation and dissociative anesthesia. Aerosolized drug delivery offers a noninvasive, well-tolerated, and cost-effective route with rapid systemic absorption. The present study aimed to compare the sedative efficacy and safety of aerosolized Dexmedetomidine versus aerosolized Ketamine as premedicants prior to general anesthesia in children undergoing elective surgery.

Methods: This prospective, double-blind, randomized controlled trial included 75 pediatric patients (both sexes, aged 3-10 years) classified as American Society of Anesthesiologists (ASA) physical status I or II. All participants were scheduled for elective surgical procedures lasting 30-90 minutes under general anesthesia. Subjects were randomly allocated into three equal groups; Group D (DexM) that received aerosolized Dexmedetomidine 3 µg/kg, Group K (KET) that received aerosolized Ketamine 3 mg/kg, Group C (Control) that received aerosolized normal saline.

Results: After 15 minutes of nebulization, Ramsay sedation scores were comparable between DexM and KET groups. At 30 minutes, DexM achieved significantly higher sedation scores compared to KET. DexM also demonstrated superior parental separation and mask acceptance compared with KET. Heart rate (HR) prior to anesthesia induction was significantly lower in the DexM group versus KET and control groups, indicating greater hemodynamic stability. Recovery and discharge times did not differ significantly among the three groups. Hypersalivation was observed more frequently with Ketamine, while the incidence of other adverse effects (nausea, vomiting, bradycardia, hypotension, or hypoxia) was negligible across all groups.