A Comparative study of oral Dexmedetomidine,Ketamine alone Versus a combination of both as premedication in paediatric patients posted for surgery

INTRODUCTION:  Anaesthesia and Surgery can be stressful and traumatic experiences for children. They are especially vulnerable to long term Psychological Impairment resulting from stress. Incidence of pre-op anxiety is about 60-70 %in paediatric patients. This is associated with increased risks of negative effects as difficult induction, post-operative agitation and increased post-op pain.

Premedication are frequently administered in children to alleviate the stress and fear of treatmen well as to ease child-parent separation and promote a smooth induction of anaesthesia. Different kinds of medications have been used for pre-medication such as anticholinergic drugs, opioids, benzodiazepines and ketamine. On literature search there are various studies on Oral midazolam, In those studies It alleviates an

and provide adequate sedation but has increased Risk of Respiratory Depression. Various studies

have been done for Oral premedication as alone or in combination, comparing Ketamine and

Midazolam, but very few studies compared the Oral Dexmedetomidine and Oral Ketamine. Clonidine has significant analgesic properties because of its alpha-2-adrenergic agonism. One major downside of clonidine is longer duration of onset requiring administration 60 minutes before anaesthesia induction. Ketamine is an easily administered parental anaesthetic that produces profound analgesia in sub- anaesthetic doses and lacks the cardiorespiratory depression seen with most other general anaesthetics. Ketamine is a phencyclidine derivative which acts on the n-methyl d-aspartate rece and causes central dissociation of the cerebral cortex while providing amnesia and analgesia and applied for premedication in different studies. Ketamine is most commonly used as premedicatio have been used to provide sedation and analgesia but may cause Nausea and Vomiting. New Drugs such as Dexmedetomidine which is an Alpha-2-Agonist have emerged as an alternative for Premedication in Paediatric Anaesthesia having sedative, analgesic and anxiolytic property minimal respiratory depression and better Peri Operative Haemodynamic stability. Dexmedetomidine and ketamine exhibit complementary pharmacological effects. Dexmedetomidine reduces cardiovascular responses and postoperative psychiatric adverse reactions attributed to

AIMS OF THE STUDY:

Primary: Compare the effects of Dexmedetomidine, Ketamine and combination of both in sedation, analgesia and reducing anxiety

Secondary: Our study will compare oral Dexmedetomedine, oral ketamine and combination of both in their effects on the ease of separation from parents, the acceptance for IV

cannulation and face mask application Expected outcome: To know the better pre-medication drug among children between oral

ketamine, oral dexmedetomidine and combination of both

METHODOLOGY OF THE STUDY:

This will be a Randomised, Comparative. Double Blinded Prospective Study of 90 Patients between 2- 12 Years of Age.

All Patients of ASA I and II Posted for Surgery between 2-12 years of age will be enrolled in the Study.

RISKS

No major risk involved

BENEFITS OF THE STUDY

Smooth induction

Less peri-operative anxiety

Less requirement of additional sedative doses of Ketamine

Easy parental separation

IV acceptability is good

Easy mask acceptance

Convenient and appealing method of sedation