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Published in: Trials 1/2023

Open Access 01-12-2023 | Ketamine | Study protocol

Two-center randomized controlled trial comparing oral chloral hydrate and intranasal combination of dexmedetomidine and ketamine for procedural sedation in children: study protocol

Authors: Young-Eun Jang, Eun-Young Joo, Ji-Hyun Lee, Eun-Hee Kim, Pyoyoon Kang, Jung-Bin Park, Hee-Soo Kim, Jin-Tae Kim

Published in: Trials | Issue 1/2023

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Abstract

Background

Oral chloral hydrate is widely used in pediatric sedation. Intranasal dexmedetomidine has been increasingly used for pediatric sedation; however, its improvement is warranted. The combination of dexmedetomidine with ketamine can improve onset and hemodynamic stability while maintaining sedative efficacy. This study aims to determine the efficacy and safety of intranasal combination of dexmedetomidine and ketamine compared to oral chloral hydrate.

Methods

This is a prospective, parallel-arm, single-blinded, two-center, superiority randomized controlled trial with 1:1 allocation, designed to compare the effects of intranasal combination of dexmedetomidine and ketamine with those of oral chloral hydrate. We shall enroll 136 patients aged < 7 years old in this study. Prior to the procedure, we shall randomize each patient into the control group (oral chloral hydrate 50 mg/kg) or study group (intranasal dexmedetomidine 2 μg/kg and ketamine 3 mg/kg). The primary outcome will be the rate of achieving an adequate sedation level (6-point Pediatric Sedation State Scale 1, 2, or 3) within 15 min. In addition, we shall measure the sedation time, sedation failure rate, completion of procedure, adverse events, patient acceptance, and physician satisfaction.

Discussion

This study will provide evidence of the efficacy and safety of the intranasal combination of dexmedetomidine and ketamine in comparison with oral chloral hydrate.

Trial registration

ClinicalTrials.​gov, NCT04820205. Registered on 19th March 2021
Literature
1.
go back to reference Cote CJ, Wilson S, American Academy Of P, American Academy Of Pediatric D. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6):e20191000. Cote CJ, Wilson S, American Academy Of P, American Academy Of Pediatric D. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6):e20191000.
2.
go back to reference Yang F, Liu Y, Yu Q, Li S, Zhang J, Sun M, et al. Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine. Paediatr Anaesth. 2019;29(1):85–91.CrossRef Yang F, Liu Y, Yu Q, Li S, Zhang J, Sun M, et al. Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine. Paediatr Anaesth. 2019;29(1):85–91.CrossRef
3.
go back to reference Karaoui M, Varadaraj V, Munoz B, Collins ME, Ali Aljasim L, Al Naji E, et al. Chloral hydrate administered by a dedicated sedation service can be used safely and effectively for pediatric ophthalmic examination. Am J Ophthalmol. 2018;192:39–46.CrossRef Karaoui M, Varadaraj V, Munoz B, Collins ME, Ali Aljasim L, Al Naji E, et al. Chloral hydrate administered by a dedicated sedation service can be used safely and effectively for pediatric ophthalmic examination. Am J Ophthalmol. 2018;192:39–46.CrossRef
4.
go back to reference Miller J, Xue B, Hossain M, Zhang MZ, Loepke A, Kurth D. Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. Paediatr Anaesth. 2016;26(3):266–72.CrossRef Miller J, Xue B, Hossain M, Zhang MZ, Loepke A, Kurth D. Comparison of dexmedetomidine and chloral hydrate sedation for transthoracic echocardiography in infants and toddlers: a randomized clinical trial. Paediatr Anaesth. 2016;26(3):266–72.CrossRef
5.
go back to reference Zhang W, Wang Z, Song X, Fan Y, Tian H, Li B. Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine. Paediatr Anaesth. 2016;26(3):273–9.CrossRef Zhang W, Wang Z, Song X, Fan Y, Tian H, Li B. Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans--additional chloral hydrate vs intranasal dexmedetomidine. Paediatr Anaesth. 2016;26(3):273–9.CrossRef
6.
go back to reference Cao Q, Lin Y, Xie Z, Shen W, Chen Y, Gan X, et al. Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examination. Paediatr Anaesth. 2017;27(6):629–36.CrossRef Cao Q, Lin Y, Xie Z, Shen W, Chen Y, Gan X, et al. Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examination. Paediatr Anaesth. 2017;27(6):629–36.CrossRef
7.
go back to reference Mason KP, Lubisch NB, Robinson F, Roskos R. Intramuscular dexmedetomidine sedation for pediatric MRI and CT. AJR Am J Roentgenol. 2011;197(3):720–5.CrossRef Mason KP, Lubisch NB, Robinson F, Roskos R. Intramuscular dexmedetomidine sedation for pediatric MRI and CT. AJR Am J Roentgenol. 2011;197(3):720–5.CrossRef
8.
go back to reference Siddappa R, Riggins J, Kariyanna S, Calkins P, Rotta AT. High-dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth. 2011;21(2):153–8.CrossRef Siddappa R, Riggins J, Kariyanna S, Calkins P, Rotta AT. High-dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth. 2011;21(2):153–8.CrossRef
9.
go back to reference Sheta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Paediatr Anaesth. 2014;24(2):181–9.CrossRef Sheta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Paediatr Anaesth. 2014;24(2):181–9.CrossRef
10.
go back to reference Ahmed SS, Unland T, Slaven JE, Nitu ME. High dose dexmedetomidine: effective as a sole agent sedation for children undergoing MRI. Int J Pediatr. 2015;2015:397372. Ahmed SS, Unland T, Slaven JE, Nitu ME. High dose dexmedetomidine: effective as a sole agent sedation for children undergoing MRI. Int J Pediatr. 2015;2015:397372.
11.
go back to reference Cheung CW, Qiu Q, Liu J, Chu KM, Irwin MG. Intranasal dexmedetomidine in combination with patient-controlled sedation during upper gastrointestinal endoscopy: a randomised trial. Acta Anaesthesiol Scand. 2015;59(2):215–23.CrossRef Cheung CW, Qiu Q, Liu J, Chu KM, Irwin MG. Intranasal dexmedetomidine in combination with patient-controlled sedation during upper gastrointestinal endoscopy: a randomised trial. Acta Anaesthesiol Scand. 2015;59(2):215–23.CrossRef
12.
go back to reference Li BL, Ni J, Huang JX, Zhang N, Song XR, Yuen VM. Intranasal dexmedetomidine for sedation in children undergoing transthoracic echocardiography study--a prospective observational study. Paediatr Anaesth. 2015;25(9):891–6.CrossRef Li BL, Ni J, Huang JX, Zhang N, Song XR, Yuen VM. Intranasal dexmedetomidine for sedation in children undergoing transthoracic echocardiography study--a prospective observational study. Paediatr Anaesth. 2015;25(9):891–6.CrossRef
13.
go back to reference Zanaty OM, El Metainy SA. A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery. Anesth Analg. 2015;121(1):167–71.CrossRef Zanaty OM, El Metainy SA. A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery. Anesth Analg. 2015;121(1):167–71.CrossRef
14.
go back to reference Lee Y, Kim J, Kim S, Kim J. Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment. J Dent Anesth Pain Med. 2016;16(1):25–9.CrossRef Lee Y, Kim J, Kim S, Kim J. Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment. J Dent Anesth Pain Med. 2016;16(1):25–9.CrossRef
15.
go back to reference Li BL, Zhang N, Huang JX, Qiu QQ, Tian H, Ni J, et al. A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by drops. Anaesthesia. 2016;71(5):522–8.CrossRef Li BL, Zhang N, Huang JX, Qiu QQ, Tian H, Ni J, et al. A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by drops. Anaesthesia. 2016;71(5):522–8.CrossRef
16.
go back to reference Lu C, Zhang LM, Zhang Y, Ying Y, Li L, Xu L, et al. Intranasal dexmedetomidine as a sedative premedication for patients undergoing suspension laryngoscopy: a randomized double-blind study. PLoS One. 2016;11(5):e0154192.CrossRef Lu C, Zhang LM, Zhang Y, Ying Y, Li L, Xu L, et al. Intranasal dexmedetomidine as a sedative premedication for patients undergoing suspension laryngoscopy: a randomized double-blind study. PLoS One. 2016;11(5):e0154192.CrossRef
17.
go back to reference Wu X, Hang LH, Wang H, Shao DH, Xu YG, Cui W, et al. Intranasally administered adjunctive dexmedetomidine reduces perioperative anesthetic requirements in general anesthesia. Yonsei Med J. 2016;57(4):998–1005.CrossRef Wu X, Hang LH, Wang H, Shao DH, Xu YG, Cui W, et al. Intranasally administered adjunctive dexmedetomidine reduces perioperative anesthetic requirements in general anesthesia. Yonsei Med J. 2016;57(4):998–1005.CrossRef
18.
go back to reference Zhang W, Fan Y, Zhao T, Chen J, Zhang G, Song X. Median effective dose of intranasal dexmedetomidine for rescue sedation in pediatric patients undergoing magnetic resonance imaging. Anesthesiology. 2016;125(6):1130–5.CrossRef Zhang W, Fan Y, Zhao T, Chen J, Zhang G, Song X. Median effective dose of intranasal dexmedetomidine for rescue sedation in pediatric patients undergoing magnetic resonance imaging. Anesthesiology. 2016;125(6):1130–5.CrossRef
19.
go back to reference Ghai B, Jain K, Saxena AK, Bhatia N, Sodhi KS. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study. Paediatr Anaesth. 2017;27(1):37–44.CrossRef Ghai B, Jain K, Saxena AK, Bhatia N, Sodhi KS. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study. Paediatr Anaesth. 2017;27(1):37–44.CrossRef
20.
go back to reference Gupta A, Dalvi NP, Tendolkar BA. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: a prospective randomized double blind trial. J Anaesthesiol Clin Pharmacol. 2017;33(2):236–40.CrossRef Gupta A, Dalvi NP, Tendolkar BA. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: a prospective randomized double blind trial. J Anaesthesiol Clin Pharmacol. 2017;33(2):236–40.CrossRef
21.
go back to reference Jun JH, Kim KN, Kim JY, Song SM. The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis. Can J Anaesth. 2017;64(9):947–61.CrossRef Jun JH, Kim KN, Kim JY, Song SM. The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis. Can J Anaesth. 2017;64(9):947–61.CrossRef
22.
go back to reference Kumar L, Kumar A, Panikkaveetil R, Vasu BK, Rajan S, Nair SG. Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatric premedication. Indian J Anaesth. 2017;61(2):125–30.CrossRef Kumar L, Kumar A, Panikkaveetil R, Vasu BK, Rajan S, Nair SG. Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatric premedication. Indian J Anaesth. 2017;61(2):125–30.CrossRef
23.
go back to reference Qiao H, Xie Z, Jia J. Pediatric premedication: a double-blind randomized trial of dexmedetomidine or ketamine alone versus a combination of dexmedetomidine and ketamine. BMC Anesthesiol. 2017;17(1):158.CrossRef Qiao H, Xie Z, Jia J. Pediatric premedication: a double-blind randomized trial of dexmedetomidine or ketamine alone versus a combination of dexmedetomidine and ketamine. BMC Anesthesiol. 2017;17(1):158.CrossRef
24.
go back to reference Xie Z, Shen W, Lin J, Xiao L, Liao M, Gan X. Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation. Am J Emerg Med. 2017;35(8):1126–30.CrossRef Xie Z, Shen W, Lin J, Xiao L, Liao M, Gan X. Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation. Am J Emerg Med. 2017;35(8):1126–30.CrossRef
25.
go back to reference Abdel-Ghaffar HS, Kamal SM, El Sherif FA, Mohamed SA. Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy. Br J Anaesth. 2018;121(2):445–52.CrossRef Abdel-Ghaffar HS, Kamal SM, El Sherif FA, Mohamed SA. Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy. Br J Anaesth. 2018;121(2):445–52.CrossRef
26.
go back to reference Miller JW, Balyan R, Dong M, Mahmoud M, Lam JE, Pratap JN, et al. Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study. Br J Anaesth. 2018;120(5):1056–65.CrossRef Miller JW, Balyan R, Dong M, Mahmoud M, Lam JE, Pratap JN, et al. Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study. Br J Anaesth. 2018;120(5):1056–65.CrossRef
27.
go back to reference Olgun G, Ali MH. Use of intranasal dexmedetomidine as a solo sedative for MRI of infants. Hosp Pediatr. 2018;8(2):68–71.CrossRef Olgun G, Ali MH. Use of intranasal dexmedetomidine as a solo sedative for MRI of infants. Hosp Pediatr. 2018;8(2):68–71.CrossRef
28.
go back to reference Reynolds J, Sedillo DJ. The evolving role of intranasal dexmedetomidine for pediatric procedural sedation. Hosp Pediatr. 2018;8(2):115–7.CrossRef Reynolds J, Sedillo DJ. The evolving role of intranasal dexmedetomidine for pediatric procedural sedation. Hosp Pediatr. 2018;8(2):115–7.CrossRef
29.
go back to reference Abdellatif MK, Ibrahim TH. Dexmedetomidine/propofol versus dexmedetomidine/ketamine versus dexmedetomidine as a sole agent for pediatric sedation during MRI. Ain-Shams J Anesth. 2019;11(2). Abdellatif MK, Ibrahim TH. Dexmedetomidine/propofol versus dexmedetomidine/ketamine versus dexmedetomidine as a sole agent for pediatric sedation during MRI. Ain-Shams J Anesth. 2019;11(2).
30.
go back to reference Boriosi JP, Eickhoff JC, Hollman GA. Safety and efficacy of buccal dexmedetomidine for MRI sedation in school-aged children. Hosp Pediatr. 2019;9(5):348–54.CrossRef Boriosi JP, Eickhoff JC, Hollman GA. Safety and efficacy of buccal dexmedetomidine for MRI sedation in school-aged children. Hosp Pediatr. 2019;9(5):348–54.CrossRef
31.
go back to reference Ezz HAA. Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: a randomized clinical trial. Egyptian J Anaesthesia. 2019;33(2):141–6.CrossRef Ezz HAA. Preoperative intranasal dexmedetomidine versus intranasal ketamine for prevention of emergence agitation after sevoflurane in myringotomy patients: a randomized clinical trial. Egyptian J Anaesthesia. 2019;33(2):141–6.CrossRef
32.
go back to reference Kim JG, Lee HB, Jeon SB. Combination of dexmedetomidine and ketamine for magnetic resonance imaging sedation. Front Neurol. 2019;10:416.CrossRef Kim JG, Lee HB, Jeon SB. Combination of dexmedetomidine and ketamine for magnetic resonance imaging sedation. Front Neurol. 2019;10:416.CrossRef
33.
go back to reference Tammam TF. Comparison of the efficacy of dexmedetomidine, ketamine, and a mixture of both for pediatric MRI sedation. Egyptian J Anaesthesia. 2019;29(3):241–6.CrossRef Tammam TF. Comparison of the efficacy of dexmedetomidine, ketamine, and a mixture of both for pediatric MRI sedation. Egyptian J Anaesthesia. 2019;29(3):241–6.CrossRef
34.
go back to reference Tang Y, Meng J, Zhang X, Li J, Zhou Q. Comparison of dexmedetomidine with propofol as sedatives for pediatric patients undergoing magnetic resonance imaging: a meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med. 2019;18(3):1775–85. Tang Y, Meng J, Zhang X, Li J, Zhou Q. Comparison of dexmedetomidine with propofol as sedatives for pediatric patients undergoing magnetic resonance imaging: a meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med. 2019;18(3):1775–85.
35.
go back to reference Uusalo P, Lehtinen M, Loyttyniemi E, Manner T, Scheinin M, Saari TI. Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study. BMC Anesthesiol. 2019;19(1):22.CrossRef Uusalo P, Lehtinen M, Loyttyniemi E, Manner T, Scheinin M, Saari TI. Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study. BMC Anesthesiol. 2019;19(1):22.CrossRef
36.
go back to reference Behrle N, Birisci E, Anderson J, Schroeder S, Dalabih A. Intranasal dexmedetomidine as a sedative for pediatric procedural sedation. J Pediatr Pharmacol Ther. 2017;22(1):4–8. Behrle N, Birisci E, Anderson J, Schroeder S, Dalabih A. Intranasal dexmedetomidine as a sedative for pediatric procedural sedation. J Pediatr Pharmacol Ther. 2017;22(1):4–8.
37.
go back to reference Anttila M, Penttila J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol. 2003;56(6):691–3.CrossRef Anttila M, Penttila J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol. 2003;56(6):691–3.CrossRef
38.
go back to reference Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67(8):825–31.CrossRef Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67(8):825–31.CrossRef
39.
go back to reference Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, et al. Intranasal ketamine for procedural sedation and analgesia in children: a systematic review. PLoS One. 2017;12(3):e0173253.CrossRef Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, et al. Intranasal ketamine for procedural sedation and analgesia in children: a systematic review. PLoS One. 2017;12(3):e0173253.CrossRef
40.
go back to reference Cravero JP, Askins N, Sriswasdi P, Tsze DS, Zurakowski D, Sinnott S. Validation of the pediatric sedation state scale. Pediatrics. 2017;139(5):e20162897. Cravero JP, Askins N, Sriswasdi P, Tsze DS, Zurakowski D, Sinnott S. Validation of the pediatric sedation state scale. Pediatrics. 2017;139(5):e20162897.
41.
go back to reference Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2(5920):656–9.CrossRef Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2(5920):656–9.CrossRef
Metadata
Title
Two-center randomized controlled trial comparing oral chloral hydrate and intranasal combination of dexmedetomidine and ketamine for procedural sedation in children: study protocol
Authors
Young-Eun Jang
Eun-Young Joo
Ji-Hyun Lee
Eun-Hee Kim
Pyoyoon Kang
Jung-Bin Park
Hee-Soo Kim
Jin-Tae Kim
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Ketamine
Published in
Trials / Issue 1/2023
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-022-07033-x

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