Emergence Delirium in Pediatric Anesthesia
Conditions
Keywords
Dexmedetomidine, Burn Procedural sedation
Brief summary
The aim of this study is to compare the effects of dormicum-ketamine versus dexmedetomidine on postoperative emergence delirium in pediatric patients undergoing deep sedation for burn-related procedures
Detailed description
This prospective randomized controlled study aims to compare the effects of a midazolam-ketamine combination versus dexmedetomidine on postoperative emergence delirium in pediatric patients undergoing deep sedation for burn-related procedures. Eligible pediatric burn patients scheduled for elective dressing changes or minor interventions will be randomly assigned into two equal groups. Group I (Midazolam-Ketamine group) will receive intravenous midazolam combined with ketamine for deep sedation. Group II (Dexmedetomidine group) will receive intravenous dexmedetomidine-based sedation according to a standardized dosing protocol. Standard monitoring will be applied throughout the procedure, and sedation depth will be assessed using a validated sedation scale to ensure comparable levels of deep sedation in both groups. Emergence delirium will be evaluated postoperatively using the Pediatric Anesthesia Emergence Delirium (PAED) scale during recovery. The primary outcome will be the incidence of emergence delirium in the early postoperative period. Secondary outcomes will include hemodynamic stability, recovery profile, postoperative pain scores, need for rescue medications, and incidence of adverse events.
Interventions
DRUGMidazolam + Ketamine
Participants will receive intravenous midazolam (0.05 mg/kg) combined with ketamine (1 mg/kg). Supplemental ketamine doses (0.5 mg/kg) will be administered as needed to maintain adequate deep sedation during burn-related procedures.
Participants will receive intravenous dexmedetomidine (loading dose 1 mcg/kg over 15 minutes, followed by infusion 0.5-1 mcg/kg/hour) adjusted to maintain adequate deep sedation during burn-related procedures.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
* Age from 3 to 16 years * Both sexes * Patients classified as American Society of Anesthesiologists (ASA) Physical -Status I-II * Patients scheduled for elective burn-related procedures (e.g., burn dressing changes or minor interventions)
Exclusion criteria
* Refusal or inability to provide written informed consent from parent or legal guardian * Known allergy or hypersensitivity to any of the study medications (midazolam, ketamine, or dexmedetomidine) * Presence of hepatic dysfunction * Presence of renal dysfunction * Presence of immunological or hematological disorders * History of epilepsy, developmental delay (mental retardation), or neurological deficits * Patients receiving or requiring high doses of inotropes and/or vasopressors intraoperatively or postoperatively * Preoperative hemodynamic instability, defined as uncontrolled hypertension, hypotension, or bradycardia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of emergence delirium | within 30 minutes after end of anesthesia | Incidence of emergence delirium within 30 minutes after the end of anesthesia, defined as a Pediatric Anesthesia Emergence Delirium (PAED) Scale score ≥ 10 at any assessment point. The Pediatric Anesthesia Emergence Delirium (PAED) Scale is a validated instrument ranging from 0 to 20, where higher scores indicate more severe emergence delirium (worse outcome). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Opiod requirments | Perioperative period | Reduction in perioperative opioid requirement (measured in µg/kg of fentanyl equivalent) |
| Hemodynamic stability | Baseline (pre-sedation), intraoperative period (every 5 minutes), and up to 30 minutes postoperatively | Hemodynamic stability will be assessed by measuring heart rate (HR) and mean arterial pressure (MAP) at predefined time points. Parameters will include: Mean HR and MAP values Incidence of bradycardia (HR \< age-adjusted normal) Incidence of hypotension (MAP decrease \>20% from baseline) |
| The duration of stay in PACU | Within 30 minutes after the end of anesthesia, with assessment performed during recovery ( every 5 minutes) | The duration of stay in PACU |
Countries
Egypt
Outcome results
None listed