The combination of dexmedetomidine and propofol for sedation in pediatric patients undergoing regional anesthesia

Objective To evaluate the effectiveness and safety of the combination of dexmedetomidine and propofol for sedation in pediatrics undergoing regional anesthesia. Methods Forty-eight children aged 2-6 years old, scheduled for elective surgery under regional anesthesia, were randomly divided into the two groups. The dexmedetomidine plus propofol group(group DP,n=24)received an infusion over 10 minutes of dexmedetomidine 0.7μg/kg and propofol 1.0 to 2.5 mg/kg bolus for induction,then an infusion of dexmedetomidine 0.5μg·kg-1·h-1 and propofol 100-300μg·kg-1·min-1 for maintenance.The propofol group(group P,n=24)received a propofol 1.0 to 2.5mg/kg bolus for induction,then an infusion of propofol 150-300μg·kg-1·min-1 for maintenance.If body movement was detected during surgery,a bolus of propofol 1.0mg/kg was administered in both groups,and if there was another body movement within three minutes of the propofol bolus,a bolus of ketamine 1.0mg/kg was administered. Hemodynamic data, respiratory rate,and oxygen saturation were recorded by researchers blinded to the study drugs. Recovery time and the primary outcome were evaluated by a modified Aldrete score. The occurrence of adverse events and the amount of supplemental ketamine used were also recorded. Results The consumption of propofol in the group DP was(149.00±24.93)μg·kg-1·min-1,and in the group P was(217.00±17.90)μg·kg-1·min-1.The propofol consumption was significant lower that in group DP(t=117.94,P=0.00).The needs for supplemental ketamine bolus in the group DP was 0.50(1.00)/case,and it was 2.00(1.00)/case in group P.The need for supplemental ketamine was less in group DP(Z=-4.48,P=0.00).Hypopnea occurred in 5 cases in group P,and 0 in group DP.The incidence of hypopnea was more in group P(χ2=5.58,P=0.03). In group DP,the mean arterial pressure and heart rate at discharge were respectively(74.96±5.69)mm Hg and(101.17±9.65) bpm,and their baseline values were(81.13±7.23)mm Hg and(112.00±13.65)bpm.Both mean arterial pressure and heart rate in the group DP remained decreased at discharge(t=10.78,P=0.00;t=10.08,P=0.00;respectively). The discharge time of the group DP was(40.91±10.90)min and it was(39.67±14.95)min in group P.There was no significant difference in the discharge time(t=0.11,P=0.74). Conclusion The combination of dexmedetomidine and propofol can provide appropriate depth of sedation in pediatric patients undergoing regional anesthesia. Key words: Dexmedetomidine; Propofol; Anesthesia and sedation; Anesthesia,combined with; Children