Effect of combined versus individual intranasal dexmedetomidine and ketamine on intraocular pressure in pediatric patients

PurposeTo compare impact of intranasal infusion of dexmedetomidine, ketamine, or combination of both on IOP in children. Patient & methodsThis prospective, randomized, observational study was conducted at Benha University Hospital, Egypt and included ASA I or II children aged 1-6 years who underwent examination under sedation. They were randomly divided into three groups: Group D (dexmedetomidine 3 mu g/kg); Group DK (dexmedetomidine 1 mu g/kg with ketamine 2 mg/kg) & Group K (ketamine 4 mg/kg). We assessed IOP difference before and after sedation. Secondary outcomes were sedation scale assessment (Ramsay Sedation Score), emergency agitation and medication side effects. ResultsWe studied 118 children divided into Group D (36 patients), Group DK (42 patients) & Group K (40 patients). IOP was significantly lower in group D (13 +/- 3 mmHg) than in groups DK (16 +/- 4 mmHg) and K (17 +/- 3 mmHg), with no significant difference between groups DK and K. Ramsay 3 was higher in group K (65%) compared to groups D and DK (22.2% and 9.5%, respectively), while Ramsay 4 was higher in group D and DK (52.8% and 52.4%, respectively) compared to group K (35%). Post-sedation nausea and vomiting were higher in group K (25%) compared to groups D and DK (0% for each). Agitation was higher in group K (62.5%) than in groups D and DK (0% for each) (p < 0.001). ConclusionIntranasal dexmedetomidine and ketamine combination are viable for achieving optimal sedation in pediatric patients undergoing surgeries or medical procedures with no significant change in the IOP.