Comparison of the effects of dexmedetomidine and propofol in reducing recovery agitation in pediatric patients after ketamine procedural sedation in emergency department

Reza Azizkhani; Soheila Kouhestani; Farhad Heydari; Mehrdad Esmailian; Awat Feizi; Bahar Khalilian Gourtani; Mohammadreza Safavi

doi:10.4103/jrms.JRMS_661_20

Comparison of the effects of dexmedetomidine and propofol in reducing recovery agitation in pediatric patients after ketamine procedural sedation in emergency department

J Res Med Sci. 2021 Aug 30:26:61. doi: 10.4103/jrms.JRMS_661_20. eCollection 2021.

Authors

Reza Azizkhani¹, Soheila Kouhestani¹, Farhad Heydari¹, Mehrdad Esmailian¹, Awat Feizi², Bahar Khalilian Gourtani³, Mohammadreza Safavi⁴

Affiliations

¹ Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
² Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA.
⁴ Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Ketamine has been a safe and effective sedative agent commonly used for painful pediatric procedures in the emergency department (ED). This study aimed to compare the effect of dexmedetomidine (Dex) and propofol when used as co-administration with ketamine on recovery agitation in children who underwent procedural sedation.

Materials and methods: In this prospective, randomized, and double-blind clinical trial, 93 children aged between 3 and 17 years with American Society of Anesthesiologists Class I and II undergoing short procedures in the ED were enrolled and assigned into three equal groups to receive either ketadex (Dex 0.7 μg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg), or ketamine alone (ketamine1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation-Sedation Scale and compared between the groups.

Results: There was no statistically significant difference between the three groups with respect to age, gender, and weight (P > 0.05). The incidence of recovery agitation was 3.2% in the ketadex group, 22.6% in the ketofol group, and 22.6% in the ketamine group (P = 0.002, children undergoing short procedures were recruited). There was a less unpleasant recovery reaction (hallucination, crying, and nightmares) in the ketadex group compared with the ketofol and ketamine groups (P < 0.05). There was no difference in the incidence of oxygen desaturation between the groups (P = 0.30).

Conclusion: The co-administering of Dex to ketamine could significantly reduce the incidence and severity of recovery agitation in children sedated in the ED.

Keywords: Dexmedetomidine; ketamine; procedural sedation; propofol; recovery agitation.