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Dexmedetomidine and ketamine: An effective alternative for procedural sedation
Pediatric Critical Care, 07/11/2012
Clinical Article
Tobias JD – The available literature except for one trial is favorable regarding the utility of a combination of ketamine and dexmedetomidine for procedural sedation.
Methods- The literature contains four reports with cohorts of more than ten patients with a total of 122 patients.
- Two of these studies were prospective randomized trials.
- Additionally, there are eight single case reports or small case series (six patients or less) with an additional 21 pediatric patients.
- When used together, dexmedetomidine may prevent the tachycardia, hypertension, salivation, and emergence phenomena from ketamine, whereas ketamine may prevent the bradycardia and hypotension, which has been reported with dexmedetomidine.
- An additional benefit is that the addition of ketamine to initiate the sedation process speeds the onset of sedation, thereby eliminating the slow onset time when dexmedetomidine is the sole agent.
- Although various regimens have been reported in the literature, the most effective regimen appears to be the use of a bolus dose of both agents, dexmedetomidine (1µg/kg) and ketamine (1–2mg/kg), to initiate sedation.
- This can then be followed by a dexmedetomidine infusion (1–2µg/kg/hr) with supplemental bolus doses of ketamine (0.5–1mg/kg) as needed.