Evaluation of the Perioperative Effects of Dexmedetomidine and Midazolam-Ketamine Premedication in Strabismus Surgery

Abstract

Purpose: To evaluate the effects of intranasal dexmedetomidine and midazolam-ketamine combination for premedication on sedation quality, oculocardiac reflex development, mask tolerance, and separation from parents in children who would undergo strabismus surgery. Methods: A total of 74 patients aged 2 to 11 years, were divided into two groups. The dexmedetomidine group (n = 37) received 1 mcg/kg of dexmedetomidine and the midalozam-ketamine group (n = 37) received 0.1 mg/kg of midazolam and 7.5 mg/kg of ketamine combination intranasally. Mean arterial pressure, peripheral oxygen saturation, Ramsay Sedation Scale values, and heart rate were recorded before and after the premedication. The children's separation from the family scores were evaluated and recorded. The mask compliance was evaluated and recorded. Patients who developed oculocardiac reflex and were administered atropine were recorded. In the postoperative period, nausea and vomiting, recovery times, and postoperative agitation were evaluated. Results: Ramsay Sedation Scale scores, mask acceptance, and family separation scores were similar in both groups ( P > .05). Oculocardiac reflex was observed more in the dexmedetomidine group ( P = .048). Atro-pine requirement and postoperative nausea and vomiting rates were similar in both groups ( P > .05). Mean arterial pressures and heart rates were significantly lower in the dexmedetomidine group during the pre-medication period. The recovery time was longer in the midazolam-ketamine group ( P < .001). The incidence of postoperative agitation was significantly lower in the midazolam-ketamine group ( P = .001). Conclusions: The sedation efficacy of intranasal dexmedetomidine and midazolam-ketamine combination that were given in premedication was similar. Oculocardiac reflex was observed more with dexmedetomidine. The recovery time was prolonged in the midazolam–ketamine group, but postoperative agitation was observed less. [ J Pediatr Ophthalmol Strabismus . 2023;60(6):427–434.]