Table 1 Association of dexemedetomidine and ketamine in literature

Luscri N. et Tobias J.D. (2006) [19]

Case report

Children with trisomy 21 and OSA undergoing MRI

Ketamine (iv) 1 mg/Kg and dexmedetomidine (iv) 1 μg/Kg and maintained by a continuous infusion of dexmedetomidine (1 μg/Kg/h)

Effective sedation without hemodynamic or respiratory effects

Kandil,A.et al. (2016) [20]

Retrospective

Children with refractory OSA undergoing DISE

Group DK: Dexmedetomidine (iv) 1.9 μg/Kg (1.6 μg/Kg/h) + Ketamine (iv) 2.0 mg/Kg; Group P: Propofol (iv) 1.8 mg/Kg (248 μg/Kg/min); Group SP: Propofol (iv) 1.8 mg/Kg (192 μg/Kg/min) + Sevoflurane

Patients in Group DK had significantly fewer desaturations to< 85% during DISE compared to Group P. Patients in Group DK had significantly more successful completion of DISE (100% Group DK, 92% Group P, and 79% Group SP) as compared to Group SP

Kako H. et al. (2014) [21]

Prospective

Patients with Duchene muscular dystrophy undergoing muscle biopsy

Group A: Dexmedetomidine (iv) (1 μg/kg over 3 min, 1 μg/kg/h) + ketamine (iv) (1 mg/kg) Group B: Dexmedetomidine (iv) (0.5 mcg/kg over 3 min, 0.5 mcg/kg/h) + ketamine (iv) (1 mg/kg)

Both groups had effective sedation; a decrease in heart rate occurred after the loading dose of dexmedetomidine in both groups; shorter recovery time in group B

Goyal R. et al. (2012) [22]

Case series

Children 2–12 years old undergoing upper gastrointestinal endoscopy

Dexmedetomidine 1 μg/kg (iv) + ketamine (iv) 2 mg/kg

Adequate sedation without cardio-respiratory depression. Hiccup, vomiting and increased salivation were the most frequent side effects

Joshi VS. et al. (2017) [23]

RCT

Children undergoing cardiac catheterization

Premedication with glycopyrrolate and midazolam iv (0.05 mg/kg). Dexmedetomidine iv 1 μg/kg over 10 min (0.5 μg/kg/h) + ketamine iv 1 mg/Kg (1 mg/kg/h) vs propofol iv 1 mg/kg (100 μg/kg/hr) + ketamine iv 1 mg/kg/hr. (1 mg/kg/hr).

Dexmedetomidine and ketamine are safe and effective sedative drugs, without major side effects but long recovery time

Qiao H. et al. (2017) [24]

RCT

Children 2–5 years old undergoing premedication in eye surgery

2.5 μg/kg in dexmedetomidine vs 3 mg/kg os ketamine and 2 μg/kg in dexmedetomidine vs 6 mg/kg os ketamine 30 min before surgery.

Combination of in dexmedetomidine and os ketamine produces satisfactory separation from parents and more successful venous cannulation. Postoperative vomiting, (p = 0.0041) respiratory-related complications during the perioperative period (p = 0.0032) and postoperative psychological/psychiatric adverse events (p = 0.0152) were detected in the ketamine group.

McVey J. and Tobias D. (2010) [25]

Retrospective

Children 2–9 years old undergoing lumbar puncture for spinal anesthesia

Ketamine iv (2 mg/kg) and dexmedetomidine iv (1 μg/kg) over 3 min + dexmedetomidine (2 μg/kg/hr. for the first 30 min and 1 μg/kg/hr. until the end).

Effective sedation with limited effects on cardiovascular and ventilator function

Yang F. et al. (2019) [26]

Retrospective

Children undergoing procedural sedation

Ketamine 1 mg/Kg (in) + dexmedetomidine 2 μg/kg (in)

The rate of in sedation success was 93%, in sedation rescue was 1.8% and in sedation failure was 5.2%. Incidence of adverse events was low (0.58%). Postoperative nausea and vomiting were the most common (0.3%)

Jia JE et al. (2013) [27]

RCT

Children 2–6 years old

Group 1: 1 μg/kg in dexmedetomidine with 3 mg/kg os ketamine; Group 2: 1 μg/kg in dexmedetomidine with 5 mg/kg os ketamine; Group 3: 2 μg/kg in dexmedetomidine with 3 mg/kg os ketamine; Group 4: 2 μg/kg in dexmedetomidine with 5 mg/kg os ketamine.

Patients in Group 4 were significantly more sedated than those in Group 1 after 30 min (p = 0.036). A significantly higher proportion of patients in Group 3 (84%) and Group 4 (87%) accepted intravenous cannulation compared with those in Group 1 (40%) and Group 2 (54%) (p = 0.001).