ABSTRACT
We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 mg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. [n=30]. Patients were intubated after receiving fentanyl 1 mg/kg and rocuronium bromide 0.5 mg/kg. 21 [70%] patients in group D did not show the oculocardiac reflex [OCR] versus 7 [23%] in group P [p=0.0006]. The preoperative and postoperative agitation scores [p=0.0001 and p=0.03, respectively], the score on the Faces Pain Scale during awakening [3.0 [interquartile range, IQR 2.0-4.0] in group D and 0.0 [IQR 1.0-2.25] in group P] [p=0.001] and at the 60th postoperative minute [IQR 2.0 [1.5-3.0] in group D and 2.0 [IQR 1.5-3.0] in group P] [p=0.004], sore throat [26.6% in group D and 60% in group P] [p=0.01] and analgesic requirement [20% in group D and 53% in group P] [p=0.01] in group P were significantly higher than in group D. The Ramsay Sedation Score [RSS] in group D was significantly higher than in group P during awakening [2.0 [2.0-2.0] in group D and 4.5 [4.0-5.0] in group P] [p=0.0001]. Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery