Journal article
Dexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy
Pediatric anesthesia, Vol.24(8), pp.851-856
08/2014
DOI: 10.1111/pan.12387
PMID: 24646124
Abstract
Background: Duchenne muscular dystrophy (DMD) possesses many potential challenges for anesthetic care. Invasive and noninvasive procedures with corresponding sedation or general anesthesia are frequent and necessary for affected patients. There remains a need for a better agent or agents for procedural sedation in patients with comorbid diseases. This study prospectively evaluated a combination of ketamine with two different doses of dexmedetomidine for sedation during muscle biopsy in patients with DMD.
Methods: Dexmedetomidine 1.0 or 0.5 mu g.kg(-1) was administered as a loading dose over 3 min followed by a continuous infusion of 1.0 or 0.5 mu g.kg.h(-1). Ketamine (1 mg.kg(-1)) was administered along with the dexmedetomidine loading dose. As the procedure commenced, additional doses of ketamine (0.5 mg.kg(-1)) were administered as needed. Sedation scores, hemodynamic data, operative times, and recovery times were recorded.
Results: The study cohort included a total of 53 bicep, deltoid, or anterior tibialis muscle biopsies in 19 boys including 24 in the dexmedetomidine 1.0 mu g.kg(-1) group and 29 in the dexmedetomidine 0.5 mu g.kg(-1) group. Mean age and weight were 9.7 +/- 1.4 years and 33.3 +/- 7.7 kg in the dexmedetomidine 1.0 mu g.kg(-1) group and 8.8 +/- 1.8 years and 30.2 +/- 10.8 kg in the dexmedetomidine 0.5 mu g.kg(-1) group. No significant changes in blood pressure were noted. A decrease in heart rate (HR) occurred after the loading dose of dexmedetomidine in both groups. The HR was significantly lower in the dexmedetomidine 1.0 mu g.kg(-1) group compared with the dexmedetomidine 0.5 mu g.kg(-1) group. Total recovery time to discharge was significantly shorter in the dexmedetomidine 0.5 mu g.kg(-1) group than the dexmedetomidine 1.0 mu g.kg(-1) group (146 +/- 65 vs 174 +/- 58 min; P = 0.03), although the total ketamine dose was significantly greater in the dexmedetomidine 0.5 mu g.kg(-1) group (3.7 +/- 1.0 vs 2.0 +/- 0.5 mg.kg(-1); P < 0.01). There were no episodes of apnea or hypoventilation; however, a jaw thrust was needed in one patient in the dexmedetomidine 1.0 mu g.kg(-1) group.
Conclusion: The combination of dexmedetomidine and ketamine is safe and effective for moderately painful procedures with limited respiratory and cardiovascular effects in a high-risk patient population. Dexmedetomidine 0.5 mu g.kg(-1) as a loading dose with ketamine followed by a continuous infusion of dexmedetomidine at 0.5 mu g.kg(-1).h(-1) achieved an adequate sedation level with shorter total recovery times in the perioperative unit compared with a higher dose regimen of dexmedetomidine ( 1.0 mu g.kg(-1) loading dose followed by an infusion at 1.0 mu g.kg(-1).h(-1)).
Details
- Title: Subtitle
- Dexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy
- Creators
- Hiromi Kako - Nationwide Children's HospitalMarco Corridore - Nationwide Children's HospitalJohn Kean - Nationwide Children's HospitalJerry R. Mendell - Nationwide Children's HospitalKevin M. Flanigan - Nationwide Children's HospitalJoseph D. Tobias - Nationwide Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Pediatric anesthesia, Vol.24(8), pp.851-856
- DOI
- 10.1111/pan.12387
- PMID
- 24646124
- NLM abbreviation
- Paediatr Anaesth
- ISSN
- 1155-5645
- eISSN
- 1460-9592
- Publisher
- Wiley
- Number of pages
- 6
- Grant note
- Research Foundation at Nationwide Children's Hospital Paul D Wellstone Muscular Dystrophy Clinical Research Center, MDA, Jesse's Journey
- Language
- English
- Date published
- 08/2014
- Academic Unit
- Anesthesia
- Record Identifier
- 9985177939202771
Metrics
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