Abstract：
OBJECTIVE: Paediatric patients are given premedication in order to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child friendly method of administration is desirable. We compared intranasal administration of dexmedetomidine and ketamine in the operating room environment, to evaluate the Faces, Legs, Activity, Cry and Consolability (FLACC) score at the time of establishing intravenous access for induction of general anaesthesia.
METHODS: This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 & 2, scheduled for general anaesthesia were enrolled. Patient\'s presedation behaviour was assessed by the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received Dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received Ketamine 5 mg/kg intranasally. After 45 min, patients were transferred to the operating table where intravenous cannulation was carried out and the response to needle insertion was assessed by FLACC scale. Vital signs, including the pulse-oximetry, heart rate and respiratory rate were monitored. Side effects such as nausea, vomiting, and agitation were also recorded.
RESULTS: A significantly higher FLACC score was seen in Group D as compared to Group K (p = 0.001). The mean heart rate between two groups was found to be significantly (p = 0.001) lower in Group D compared to Group K. However, the proportion of adverse events was 8% in patients who received ketamine.
CONCLUSIONS: Intranasal ketamine in a dose of 5 mg/kg is clinically more effective as premedication in children aged 2-10 years in comparison with intranasal dexmedetomidine in a dose of 1 mcg/kg.
METHODS: This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 & 2, scheduled for general anaesthesia were enrolled. Patient\'s presedation behaviour was assessed by the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received Dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received Ketamine 5 mg/kg intranasally. After 45 min, patients were transferred to the operating table where intravenous cannulation was carried out and the response to needle insertion was assessed by FLACC scale. Vital signs, including the pulse-oximetry, heart rate and respiratory rate were monitored. Side effects such as nausea, vomiting, and agitation were also recorded.
RESULTS: A significantly higher FLACC score was seen in Group D as compared to Group K (p = 0.001). The mean heart rate between two groups was found to be significantly (p = 0.001) lower in Group D compared to Group K. However, the proportion of adverse events was 8% in patients who received ketamine.
CONCLUSIONS: Intranasal ketamine in a dose of 5 mg/kg is clinically more effective as premedication in children aged 2-10 years in comparison with intranasal dexmedetomidine in a dose of 1 mcg/kg.
摘要：
目的：儿科患者术前用药以减少术前焦虑，允许平稳的感应，并防止术后心理伤害和行为改变。儿童友好的给药方法是理想的。我们比较了手术室环境中右美托咪定和氯胺酮的鼻内给药，为了评估面孔，腿,活动,建立静脉内途径诱导全身麻醉时的CryandConsolability(FLACC)评分。
方法：这种前瞻性，双盲,随机对照试验在三级护理中心进行.一百个病人,2-10岁,纳入计划用于全身麻醉的ASA身体状况1和2。通过改良的耶鲁术前焦虑量表简表（mYPAS-SF）评估患者的抑郁行为。D组患者鼻内接受右美托咪定1mcg/kg，K组患者鼻内接受氯胺酮5mg/kg。45分钟后,患者被转移到手术台上进行静脉内插管,并通过FLACC量表评估患者对针头插入的反应.生命体征,包括脉搏血氧饱和度,监测心率和呼吸频率。副作用如恶心,呕吐,和躁动也被记录。
结果：与K组相比，D组的FLACC评分明显更高（p=0.001）。与K组相比，D组发现两组之间的平均心率显着降低（p=0.001）。在接受氯胺酮治疗的患者中,不良事件的比例为8%.
结论：与1mcg/kg剂量的鼻内右美托咪定相比，5mg/kg剂量的鼻内氯胺酮作为2-10岁儿童的术前用药在临床上更有效。
方法：这种前瞻性，双盲,随机对照试验在三级护理中心进行.一百个病人,2-10岁,纳入计划用于全身麻醉的ASA身体状况1和2。通过改良的耶鲁术前焦虑量表简表（mYPAS-SF）评估患者的抑郁行为。D组患者鼻内接受右美托咪定1mcg/kg，K组患者鼻内接受氯胺酮5mg/kg。45分钟后,患者被转移到手术台上进行静脉内插管,并通过FLACC量表评估患者对针头插入的反应.生命体征,包括脉搏血氧饱和度,监测心率和呼吸频率。副作用如恶心,呕吐,和躁动也被记录。
结果：与K组相比，D组的FLACC评分明显更高（p=0.001）。与K组相比，D组发现两组之间的平均心率显着降低（p=0.001）。在接受氯胺酮治疗的患者中,不良事件的比例为8%.
结论：与1mcg/kg剂量的鼻内右美托咪定相比，5mg/kg剂量的鼻内氯胺酮作为2-10岁儿童的术前用药在临床上更有效。
