Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial
Background We hypothesized that intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) (IN DEXKET) improves the success rate of sedation in pediatric patients compared with chloral hydrate (CH; 50 mg/kg). Methods This prospective, two-center, single-blinded, randomized controlled...
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Korean Society of Anesthesiologists
2025-06-01
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| Series: | Korean Journal of Anesthesiology |
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| Online Access: | http://ekja.org/upload/pdf/kja-24815.pdf |
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| author | Young-Eun Jang Eun-Young Joo Jung-Bin Park Sang-Hwan Ji Eun-Hee Kim Ji-Hyun Lee Hee-Soo Kim Jin-Tae Kim |
| author_facet | Young-Eun Jang Eun-Young Joo Jung-Bin Park Sang-Hwan Ji Eun-Hee Kim Ji-Hyun Lee Hee-Soo Kim Jin-Tae Kim |
| author_sort | Young-Eun Jang |
| collection | DOAJ |
| description | Background We hypothesized that intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) (IN DEXKET) improves the success rate of sedation in pediatric patients compared with chloral hydrate (CH; 50 mg/kg). Methods This prospective, two-center, single-blinded, randomized controlled trial involved 136 pediatric patients (aged < 7 years) requiring procedural sedation. The participants were randomized to receive CH or IN DEXKET via a mucosal atomizer device. The primary outcome was the success rate of sedation (Pediatric Sedation State Scale, scores 1–3) within 15 min. The secondary outcomes included sedation failure at 30 min and overall complications of first-attempt sedation. Results After excluding eight patients, 128 were included (CH = 66, IN DEXKET = 62). IN DEXKET showed a similar sedation success rate (75.8% [47/62] vs. 66.7% [44/66]; P = 0.330) but a lower complication rate (3.2% [2/62] vs. 16.7% [11/66]; P = 0.017) than CH. In the subgroup analysis for patients aged < 1 year, IN DEXKET showed a reduced complication rate than CH (2.6% [1/38] vs. 22.9% [8/35]; P = 0.012). In the subgroup analysis of children aged 1–7 years, IN DEXKET showed a higher sedation success rate within 15 min (79.2% [19/24] vs. 51.6% [16/31]; P = 0.049) and a lower sedation failure after 30 min (0% vs. 29.0% [9/31]; P = 0.003) than CH. Conclusions The intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) is a safe and effective alternative to CH (50 mg/kg) for sedation in pediatric patients aged < 7 years. |
| format | Article |
| id | doaj-art-a6ea98d2337949bbb77ce10e455c4ad7 |
| institution | Kabale University |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Korean Society of Anesthesiologists |
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| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-a6ea98d2337949bbb77ce10e455c4ad72025-08-20T03:58:39ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632025-06-0178324826010.4097/kja.248159056Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trialYoung-Eun Jang0Eun-Young Joo1Jung-Bin Park2Sang-Hwan Ji3Eun-Hee Kim4Ji-Hyun Lee5Hee-Soo Kim6Jin-Tae Kim7 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, KoreaBackground We hypothesized that intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) (IN DEXKET) improves the success rate of sedation in pediatric patients compared with chloral hydrate (CH; 50 mg/kg). Methods This prospective, two-center, single-blinded, randomized controlled trial involved 136 pediatric patients (aged < 7 years) requiring procedural sedation. The participants were randomized to receive CH or IN DEXKET via a mucosal atomizer device. The primary outcome was the success rate of sedation (Pediatric Sedation State Scale, scores 1–3) within 15 min. The secondary outcomes included sedation failure at 30 min and overall complications of first-attempt sedation. Results After excluding eight patients, 128 were included (CH = 66, IN DEXKET = 62). IN DEXKET showed a similar sedation success rate (75.8% [47/62] vs. 66.7% [44/66]; P = 0.330) but a lower complication rate (3.2% [2/62] vs. 16.7% [11/66]; P = 0.017) than CH. In the subgroup analysis for patients aged < 1 year, IN DEXKET showed a reduced complication rate than CH (2.6% [1/38] vs. 22.9% [8/35]; P = 0.012). In the subgroup analysis of children aged 1–7 years, IN DEXKET showed a higher sedation success rate within 15 min (79.2% [19/24] vs. 51.6% [16/31]; P = 0.049) and a lower sedation failure after 30 min (0% vs. 29.0% [9/31]; P = 0.003) than CH. Conclusions The intranasal combination of dexmedetomidine (2 μg/kg) and ketamine (3 mg/kg) is a safe and effective alternative to CH (50 mg/kg) for sedation in pediatric patients aged < 7 years.http://ekja.org/upload/pdf/kja-24815.pdfadministration, intranasalchloral hydrateconscious sedationdeep sedationdexmedetomidinedrug-related side effects and adverse reactionshypnotics and sedativesketaminepediatrics |
| spellingShingle | Young-Eun Jang Eun-Young Joo Jung-Bin Park Sang-Hwan Ji Eun-Hee Kim Ji-Hyun Lee Hee-Soo Kim Jin-Tae Kim Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial Korean Journal of Anesthesiology administration, intranasal chloral hydrate conscious sedation deep sedation dexmedetomidine drug-related side effects and adverse reactions hypnotics and sedatives ketamine pediatrics |
| title | Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial |
| title_full | Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial |
| title_fullStr | Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial |
| title_full_unstemmed | Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial |
| title_short | Comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation: a randomized controlled trial |
| title_sort | comparison of combined intranasal dexmedetomidine and ketamine versus chloral hydrate for pediatric procedural sedation a randomized controlled trial |
| topic | administration, intranasal chloral hydrate conscious sedation deep sedation dexmedetomidine drug-related side effects and adverse reactions hypnotics and sedatives ketamine pediatrics |
| url | http://ekja.org/upload/pdf/kja-24815.pdf |
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