Ketamine, single dose, 10 mg/kg (0.1 mL/kg) of 100 mg/mL solution delivered intranasally using an atomizer and divided to both nares to a maximum of 800 mg (8 mL) AND 0.9% normal saline (NS) 0.02 to 0.03 mL/kg delivered intravenously to a maximum of 2.4 mL

Ketamine, single dose, 1 to 1.5 mg/kg (0.02 to 0.03 mL/kg) of 50 mg/mL solution delivered intravenously, to a maximum of 120 mg (2.4 mL) AND 0.9% normal saline (NS) 0.1 mL/kg delivered intranasally using an atomizer and divided to both nares, to a maximum of 8 mL

Bone Fractures

Dislocations

Intranasal ketamine 100 mg/mL solution (10 mg/kg, maximum 800 mg)

IN ketamine

Intravenous ketamine 50 mg/mL solution (1 to 1.5 mg/kg, maximum 120 mg)

IV ketamine

IN saline 0.9%

IV saline 0.9%

Intranasal Ketamine for Procedural Sedation

Intranasal Ketamine Versus Intravenous Ketamine for Procedural Sedation in Children: a Multi-centre Randomized Controlled Non-inferiority Trial

Proportion with DOCS score -2 to +2 for duration of fracture reduction

Score using Pediatric Sedation State Scale

Time interval from first IN sprays to first DOCS score between -2 and +2 in minutes

Duration of time between the first DOCS score -2 to +2 to last DOCS score between -2 and +2 post-fracture reduction

Proportion of time DOCS score is -2 to +2 during fracture reduction.

The proportion of participants with adverse effects between groups will be compared. The list of adverse effects was chosen based on known adverse effects associated with ketamine and consensus-based recommendations for reporting for procedural sedation and analgesia in children.

Time interval from the first pair of IN sprays to discharge

Time of the first pair of IN sprays to the end of cast or splint application

Obtained when patient is awake and drinking using a Visual Analog Scale; Parents not wishing to remain in proximity of child for sedation may opt out

Obtained when patient is awake and drinking using a Visual Analog Scale; Satisfaction will only be assessed in children at least eight years of age as the VAS has not been validated in younger children.

Obtained immediately prior to discharge using a Visual Analog Scale

Number of doses and type of adjunctive sedative medication required; Deemed inadequate if additional sedative medication given (for IN ketamine group only)

Number of doses and type of analgesic medication required

Pain scores will be recorded using the FPS-R on arrival and when the child is awake and drinking

The proportion of children experiencing emergence delirium will be compared using the Paediatric Anesthesia Emergence Delirium (PAED) scale scored from the video every 5 minutes by an outcome assessor starting when fracture reduction is complete to when awake and drinking

Measured using the Faces Pain Scale - Revised when awake and drinking

Successful sedation - Based on the definition of Bhatt et al., this will be defined as no unpleasant patient recall of the procedure, no resistance or restraint required during the procedure, no permanent sedation-related complication or no sedation-related event requiring abandonment of the procedure.
Defined as: no unpleasant patient recall of the procedure, no resistance or restraint required during the procedure, no permanent sedation-related complication or no sedation-related event requiring abandonment of the procedure.
Defined as no unpleasant recall of procedure, no resistance or restraint, no permanent sedation related complication, no sedation-related event requiring abandonment of procedure

Other reasons for IV insertion (analgesia, anxiolysis, fluids, etc.)

Number of IN sprays received / Intended number of sprays

Number of IV attempts and time to IV insertion Number of IV attempts

Time from first breakage of skin to establishment of successful flow with a flush

Lawson Health Research Institute

active comparator receive 0.5µg/kg dexmedetomidine orally half an hour before operation

2ml oral 0.9%saline half an hour before operation

active comparator receive,1µg/kg dexmedetomidine orally half an hour before operation

Agitation

Dexmedetomidine

2ml 0.9% saline administered orally half an hour before induction of anesthesia

saline

Assiut university hospitals

Transbucal Dexmedetomidine for Prevention of Sevoflurane Emergence Agitation in Pre-school Children

Transbucal Dexmedetomidine for the Prevention of Emergence Agitation After Sevoflurane Anaesthesia in Pre-school Children

Agitation intensity will be assessed postoperatively by using agitation score 0= child is asleep. awake/calm =1. irritable/ consolable cry =2. inconsolable cry =3.the child is agitating and thrashing and restlessness Emergence delirium ≥ 3 agitation score will be performed in the following time points; at 5 min postoperative,10 min, 15, 30, 45, 60 min.

Pain intensity will be assessed postoperatively by using the objective pain scale. objective pain scale assessments will be performed in the following time points; at 5 min postoperative, 10 min, 15, 30, 45, 60 min.

Hala Saad Abdel-Ghaffar

Assiut University

Inhaled sevoflurane 8% during induction of general anesthesia (from the start of gas administration to the insertion of a laryngeal mask).
After laryngeal mask insertion, sevoflurane will be reduced to 4%. Caudal block with L-bupivacaine 0.25% will be performed in all children.
After caudal block, sevoflurane will be reduced to 0.75 MAC according to age of the child and maintained until the end of surgery After surgery, PAED and pain scales will be administered every 15 minutes up to 2 hours after surgery.

Inhaled sevoflurane 5% during induction of general anesthesia (from the start of gas administration to the insertion of a laryngeal mask).
After laryngeal mask insertion, sevoflurane will be reduced to 4%. Caudal block with L-bupivacaine 0.25% will be performed in all children.
After caudal block, sevoflurane will be reduced to 0.75 MAC according to age of the child and maintained until the end of surgery After surgery, PAED and pain scales will be administered every 15 minutes up to 2 hours after surgery.

Delirium

Sevoflurane 8% (high dose) during anesthesia induction

Sevoflurane 8%

Sevoflurane 5% (low dose) during anesthesia induction

Sevoflurane 5%

División de Anestesia - Facultad de Medicina Pontificia Universidad Católica

Different Doses of Sevoflurane During Induction of Anesthesia on Emergence Delirium in Children

Emergence Delirium in Children: a Randomized Clinical Trial of Different Doses of Sevoflurane During Induction of Anesthesia

Emergence delirium will be evaluated with the Pediatric Anesthesia Emergence Delirium scale every 15 minutes

Pain will be evaluated according to age of children: CHIPPS scale for under 3 years, faces for children between 4 and 6 years old, Visual Analogue Scale (VAS) with older children.

Bispectral Index (BIS) monitoring will be used during surgery and recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery

Measured with pulse oximetry, recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery

Measured with non-invasive blood pressure cuff, recorded at following times: after insertion of IV access, after insertion of laryngeal mask, after caudal block, after lowering dose of sevoflurane to 0.75 MAC, after skin incision, at the end of surgery

emergence delirium/epileptischer anfall

Intranasal Ketamine for Procedural Sedation

Transbucal Dexmedetomidine for Prevention of Sevoflurane Emergence Agitation in Pre-school Children

Different Doses of Sevoflurane During Induction of Anesthesia on Emergence Delirium in Children

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