Dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children undergoing bronchoscopic fiberoptic intubation

• Main Author: Mostafa M Sabra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Al-Azhar Assiut Medical Journal
• Subjects: dexmedetomidine; fiberoptic bronchoscopy; ketamine; magnesium sulfate; pediatrics
• Online Access: http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2018;volume=16;issue=3;spage=255;epage=261;aulast=Sabra

Background and aims Meticulous airway management, with the support of satisfactory sedation while keeping up a patent airway and guaranteeing ventilation, is an integral part for conscious sedation for bronchoscopic fiberoptic intubation in pediatric patients. This randomized double-blinded, prospective, comparative, clinical study aimed to compare the effects of dexmedetomidine-ketamine versus magnesium sulfate-ketamine for sedating children experiencing bronchoscopic fiberoptic intubation. The primary outcome was intubation scores as assessed by (a) vocal cord movement, (b) coughing, and (c) limb movement. Secondary outcomes were intubation time and patient tolerance using fiberoptic intubation comfort score. Patients and methods A total of 60 patients having American Society of Anesthesiologist grade I aged between 7 and 14 years undergoing elective minor infraumbilical surgeries were included in the study. Patients were randomly allocated to one of two groups: group DK patients (n=30) received intravenous loading dose of dexmedetomidine (2 µg/kg) in 20 min, and then were maintained by 0.5 µg/kg/h infusion until successful placement of the tube in the trachea, and intravenous ketamine (0.5 mg/kg/h) after finishing the loading dose, and just before fiberoptic intubation, and group MK patients (n=30) received intravenous loading dose of magnesium sulfate (40 mg/kg) in 20 min, and then were maintained by 10 mg/kg/h until successful placement of the tube in the trachea, and ketamine (0.5 mg/kg) after finishing the loading dose, and just before fiberoptic intubation. Continuous data were summarized as mean±SD, whereas discrete (categorical) in percentage. The groups were compared by independent Student’s ‘t’ test. The discrete (categorical) variables were compared by χ2-test. Results Intubation scores were better in group DK than group MK for vocal cord movement (P=0.009) and limb movement (P=0.0016), but there was no statistically significant difference in coughing (P=0.89). Time required for intubation was significantly less in group DK, as compared with the group MK (76.4±13.25 and 89.83±20.069 s, P=0.043). There was better fiberoptic intubation comfort score in group DK (P=0.0032). All patients were successfully intubated through fiberoptic bronchoscope in both groups. There were no significant hemodynamic changes between the two groups. Conclusion Intravenous dexmedetomidine/ketamine improved awaken bronchoscopic fiberoptic intubation in children with better intubation scores, intubation tolerance, and less intubation time when compared with magnesium sulfate-ketamine.