Anest. intenziv. Med. 2008;19(2):87-90

Dexmedetomidine-ketamine intravenous sedation during local anaesthesiaAnaesthesiology - Original Paper

Málek Jiří^1,*, Hess Ladislav², Hrehorová Zuzana¹, Šklíba Vojtěch¹

¹ Klinika anesteziologie a resuscitace 3. LF UK Praha a FNKV

² IKEM Praha

Objective:
To evaluate the combination of dexmedetomidine and ketamine for analgesic sedation.

Design:
Prospective randomised clinical study.


Setting:
Department of Anaesthesiology and Intensive Care, University Hospital.

Materials and methods:
Patients scheduled for Dupuytren's contracture repair under local anaesthesia were randomly divided to groups C and D. Group D patients were administered an infusion of dexmedetomidine 1 μg . ml⁻¹ and ketamine 1 mg . ml⁻¹ in normal saline as follows: 10 minutes before surgery a bolus of 0.04 ml . kg⁻¹ (e. g. dexmedetomidine 0.04 µg . kg⁻¹, ketamine 0.04 mg . kg⁻¹) was given, followed by infusion of 2 ml . kg⁻¹. h⁻¹ for the first 10 minutes (dexmedetomidine 2 μg . kg⁻¹ . h⁻¹, ketamine 2 mg . kg⁻¹ . h⁻¹) and 1 ml . kg⁻¹ . h⁻¹ (dexmedetomidine 1 μg . kg⁻¹ . h⁻¹, ketamine 1 mg . kg⁻¹ . h⁻¹) for the rest of surgery. Group C patients were given normal saline. Vital functions, analgesia and Ramsay score were measured.

Results:
There were 7 patients in group C and 8 patients in group D. The demographic characteristics were comparable between the groups. We found differences between groups C and D in Ramsay score (all group C patients scored 1 point vs. 7 group D patients scored 2 points and one patient scored 3 points, p < 0.001), absence of reaction to painful application of local anaesthetic and tourniquet (0 vs. 6, p = 0.02), amnesia (0 vs. 6, p = 0.02) and light-headedness 1 hour after surgery (0 vs. 7, p = 0.005). Five patients in group D remembered dreams (NS). There was a slight fall in blood pressure (25-30% below base-line) in 4 patients in group D (NS) and no change in ventilation.

Conclusions:
The combination of dexmedetomidine and ketamine provides analgesia, amnesia and catatonia with preserved cooperation, and has no respiratory effects.

Keywords: analgesic sedation; dexmedetomidine; ketamine

Received: November 13, 2007; Accepted: January 5, 2008; Published: April 1, 2008  Show citation