Comparison of intranasal ketamine versus intranasal dexmedetomidine as a pre-medication during induction of anesthesia in pediatric patients

Abstract

Background: Preoperative anxiety in children undergoing surgery can complicate anesthetic induction and adversely affect perioperative outcomes. Intranasal administration of premedication is a non-invasive route that provides rapid drug absorption and good patient compliance. This study compared the efficacy of intranasal ketamine and intranasal dexmedetomidine as premedication in pediatric patients undergoing elective surgery. Methods: This double-blind randomized controlled trial was conducted at the Department of Anesthesia, Children's Hospital Lahore, from January 2026 to May 2026. A total of 134 children aged 2–6 years with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective ENT surgery were randomly assigned to receive either intranasal ketamine (5 mg/kg; Group K, n = 67) or intranasal dexmedetomidine (1 μg/kg; Group D, n = 67). The primary outcome was effective mask acceptance, defined as a Mask Acceptance Score (MAS) ≤2 during anesthetic induction. Secondary outcomes included hemodynamic parameters, induction time, and adverse events, including coughing, sneezing, and postoperative nausea and vomiting (PONV). Results: Baseline demographic and clinical characteristics were comparable between the groups. Effective mask acceptance (MAS ≤2) was achieved in 85.1% of children receiving dexmedetomidine compared with 67.2% receiving ketamine (p < 0.05). Poor mask acceptance (MAS = 3) occurred more frequently in the ketamine group (32.8%) than in the dexmedetomidine group (14.9%). Heart rate, oxygen saturation, and induction time did not differ significantly between groups (p > 0.05). The incidence of postoperative nausea and vomiting was higher in the ketamine group (25.4%) than in the dexmedetomidine group (10.4%), although the difference was not statistically significant. Similarly, coughing and sneezing were more frequent with ketamine, but not statistically significant. Conclusion: Intranasal dexmedetomidine provided significantly better mask acceptance than intranasal ketamine while maintaining comparable hemodynamic stability and induction time. Although adverse events were numerically fewer with dexmedetomidine, these differences were not statistically significant. Intranasal dexmedetomidine appears to be the preferred premedication for facilitating smooth anesthetic induction in pediatric patients undergoing elective surgery.