Anest. intenziv. Med. 2008;19(2):82-86

Intramuscular dexmedetomidine in burns victims - preliminary resultsAnaesthesiology - Original Paper

Málek Jiří^*, Hess Ladislav², Jandová Jaroslava¹, Šimánková Eva¹

¹ Klinika anesteziologie a resuscitace 3. LF Univerzity Karlovy v Praze a FNKV, Praha

² IKEM, Praha

Objective:
The aim was to evaluate the combination of dexmedetomidine and ketamine and dexmedetomidine, ketamine and midazolam.

Design:
Prospective randomised clinical study.


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


Materials and methods Part 1:
Following ethics committee approval and written consent, patients treated for burns were divided into 4 groups according to the intramuscular dose of dexmedetomidine (D) 2 μg .kg⁻¹ or 2.5 μg .kg⁻¹ and ketamine (K) 2.0 mg.kg⁻¹ or 3.0 mg.kg⁻¹.


Results Part 1:
Total 43 anaesthetics were given to 18 patients. Combinations D2K2 and D2.5K3 were stopped for insufficient effect or excessive sedation respectively. No respiratory depression, airway obstruction, bradycardia or hypotension appeared and any combination suppressed the psychomimetic reactions to ketamine. The only difference found between D2K3 vs D2.5K2 was preserved cooperation in the former combination (p < 0.05).


Materials and methods Part 2:
To suppress the CNS effects of ketamine, either midazolam (M) 1 mg IM or placebo (P) was added to the combination of dexmedetomidine 2 μg . kg⁻¹ + ketamine 2 mg . kg⁻¹ (DKM or DKP combinations). The protocol was identical to Part 1.


Results Part 2:
The study was prematurely aborted after signs of excessive sedation in 7 patients and airway obstruction in some patients. Unconsciousness appeared in 5/7 vs. 0/7 in the DKM vs. DKP group (p < 0.05), the quality of anaesthesia improved in 4 patients in the DKM group.

Conclusions:
The combination of intramuscular dexmedetomidine 2.5 μg . kg⁻¹ with ketamine 2.0 mg . kg⁻¹ is more likely to preserve cooperation during anaesthesia than dexmedetomidine 2 μg . kg⁻¹with ketamine 3.0 mg . kg⁻¹ IM. Adding 1-2 mg of midazolam may result in vital function disturbances.

Keywords: general anaesthesia; analgesic sedation; management of the burn patient; intramuscular administration; dexmedetomidine; ketamine; midazolam

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