Comparison of dexmedetomidine versus nalbuphine in ketamine based procedural sedation for pediatric cathlab procedures: A prospective double blinded randomized trial

Abstract

: The aim of the current study was to compare the effects of nalbuphine and dexmedetomidine as premedication sedative agent for ketamine based deep sedation on hemodynamics, sedation level and need for additional boluses of ketamine, and recovery time in pediatric patients undergoing various cardiac catheterization procedure.: Sixty pediatric patients undergoing cardiac catheterization were enrolled in the current study. Patients were randomly distributed to two equal groups of 30 patients each: Group D and Group N. Patients randomized to Group D received a bolus of dexmedetomidine at 1 μg/kg over 10 min and Group N received a bolus of nalbuphine 0.1 mg/kg over 10min. In both the groups patients were induced with Inj ketamine 2mg/kg. After induction dose inj ketamine 0.5mg/kg boluses were given to achieve and maintain the target Ramsay Sedation Score (RSS)≥ 4. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SPO2), and sedation scores were recorded. Recovery time, perioperative adverse events, and total ketamine consumption required for anesthesia maintenance were also recorded.: There was significant decreased in HR from baseline in group D at 10, 20, and 30min of the procedure with no significant difference as regards the MAP between the two study groups. Ketamine consumption in group N was significantly lower than in group D to maintain RSS in desired range. The recovery time was significantly shorter in group N when compared with group D. Respiratory variables were maintained in both the groups with two patients reported airway obstruction which was partial. No significant difference was found in intra and postoperative adverse effect between the groups. : The nalbuphine was found to be superior to dexmedetomidine as a premedication sedation for pediatric cathlab procedure in terms of reduced consumption of ketamine for adequate intraoperative sedation to conduct the procedure with better hemodynamic control and the shorter recovery time.