Research Article

A Comparative Study of the Effect of Dexmedetomidine-Fentanyl and Midazolam-Ketamine Combination on the Level of Sedation in Children undergoing Bone Marrow Biopsy

Abstract

Background: This study aimed to compare the effect of dexmedetomidine-fentanyl (DF) and midazolam-ketamine (MK) combination on the level of sedation in children undergoing bone marrow biopsy.
Methods: This study was a single-blind randomized clinical trial. The patients were divided into two groups of 35. Five minutes before undergoing bone marrow biopsy, the first group underwent sedation with a combination of 0.1 mg/kg midazolam with 1 mg/kg ketamine, and the second group underwent sedation with a combination of 2 μg/kg dexmedetomidine with 1 μg/kg fentanyl. The mean arterial pressure (MAP), heart rate, SpO2, the level of sedation, and the incidence rates of complications were recorded in both groups and compared to each other.
Results: There was no significant difference between the two groups in terms of age (P= 0.687), gender (P= 1.00), and weight (P= 0.839). However, there was a significant difference in the average length of stay in recovery (P= 0.015) and surgeon satisfaction (P= 0.000), with a longer recovery period in the midazolam-ketamine (MK) group. The Repeated measures ANOVA showed significant differences in heart rate (P= 0.008), sedation score (P = 0.038), and the percentage of oxygen saturation (P= 0.00) during surgery.
Conclusion: The combination of dexmedetomidine and fentanyl (DF) compared to the combination of midazolam and ketamine (MK) can provide more patient sedation and surgeon satisfaction along with more stable hemodynamics for patients undergoing bone marrow biopsy.

[1] Bhatnagar S, Mishra S, Gupta M, Srikanti M, Mondol A, Diwedi A. Efficacy and safety of a mixture of ketamine, midazolam and atropine for procedural sedation in paediatric oncology: a randomised study of oral versus intramuscular route. J Paediatr Child Health. 2008; 44(4): 201-4.
[2] Jay S, Elliott CH, Fitzgibbons I, Woody P, Siegel S. A comparative study of cognitive behavior therapy versus general anesthesia for painful medical procedures in children. Pain. 1995; 62(1): 3-9.
[3] Ghasemi A, Gharavi FM, Sabzevari A. General anesthesia for lumbar puncture and bone marrow aspiration /biopsy in children with cancer. Iran J Ped Hematol Oncol. 2013; 3(2): 54-8.
[4] Hockenberry MJ, McCarthy K, Taylor O, Scarberry M, Franklin Q, Louis CU, et al. Managing painful procedures in children with cancer. J Pediatr Hematol Oncol. 2011; 33(2): 119-27.
[5] Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S, et al. Premedication in the United States: A status report. Anesth Analg. 1997; 84:427–32.
[6] Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine: An alternative to benzodiazepines for premedication in children. Curr Opin Anaesthesiol. 2005; 18:608–13.
[7] Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine in paediatric anaesthesia: Review of the literature and comparison with benzodiazepines for premedication. Acta Anaesthesiol Scand. 2006; 50:135–43.
[8] Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004; 44:460–71.
[9] Nagdeve NG, Yaddanapudi S, Pandav SS. The effect of different doses of ketamine on intraocular pressure in anesthetized children. J Pediatr Ophthalmol Strabismus. 2006; 43:219–23.
[10] Ogawa S, Seino H, Ito H, Yamazaki S, Ganzberg S, Kawaai H, et al. Intravenous sedation with low-dose dexmedetomidine: It's potential for use in dentistry. Anesth Prog. 2008; 55:82–8.
[11] Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatr Clin North Am. 2007; 54:645–72.
[12] Grape S, Schug SA, Lauer S, Schug BS. Formulations of fentanyl for the management of pain. Drugs. 2010; 70:57–72.
[13] Funk W, Jakob W, Riedl T, Taeger K. Oral preanaesthetic medication for children: Double-blind randomized study of a combination of midazolam and ketamine vs. midazolam or ketamine alone. Br J Anaesth. 2000; 84:335–40.
[14] Astuto M, Disma N, Crimi E. Two doses of oral ketamine, given with midazolam, for premedication in children. Minerva Anestesiol. 2002; 68:593–8.
[15] Abdolkarimi B, Zareifar S, Golestani Eraghi M, Saleh F. Comparison Effect of Intravenous Ketamine with Pethidine for Analgesia and Sedation during Bone Marrow Procedures in Oncologic Children: A Randomized, Double-Blinded, Crossover Trial. Int J Hematol Oncol Stem Cell Res. 2016; 10(4):206-211.
[16] Gelen SA, Sarper N, Demirsoy U, Zengin E, Çakmak E. The Efficacy and Safety of Procedural Sedoanalgesia with Midazolam and Ketamine in Pediatric Hematology. Turk J Haematol. 2015; 32(4):351-4.
[17] Barkan S, Breitbart R, Brenner-Zada G, Feldon M, Assa A, Toledano M, et al. A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair. Emerg Med J. 2014; 31:649–53.
[18] Norambuena C, Yañez J, Flores V, Puentes P, Carrasco P, Villena R, et al. Oral ketamine and midazolam for pediatric burn patients: A prospective, randomized, double-blind study. J Pediatr Surg. 2013; 48:629–34.
[19] Darlong V, Shende D, Subramanyam MS, Sunder R, Naik A. Oral ketamine or midazolam or low dose combination for premedication in children. Anaesth Intensive Care. 2004; 32:246–9
[20] Malhotra PU, Thakur S, Singhal P, Chauhan D, Jayam C, Sood R, et al. Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in pediatric dentistry: A double-blinded randomized controlled trial. Contemp Clin Dent. 2016; 7:186–92.
[21] Ghai B, Grandhe RP, Kumar A, Chari P. Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication. Paediatr Anaesth. 2005; 15:554–9.
Files
IssueVol 9 No 1 (2023): Winter QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i1.11946
Keywords
dexmedetomidine ketamine midazolam fentanyl bone marrow biopsy sedation score.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Egbali A, Shafa A, Razavi SS, Mahdavi A, Chavoshi T. A Comparative Study of the Effect of Dexmedetomidine-Fentanyl and Midazolam-Ketamine Combination on the Level of Sedation in Children undergoing Bone Marrow Biopsy. Arch Anesth & Crit Care. 2023;9(1):59-63.