Efficacy And Safety Of Esketamine Combined With Dexmedetomidine Intranasals In Sedation During Pediatric Ophthalmic Examination

Background:Children as a special group,examination is often accompanied by fear,the physical and mental impact on children,on the other hand,affect the accuracy of the examination results,delay the treatment of children.Ophthalmic examination requires high eye position,which requires eyeball fixation to facilitate the operation of the examiner and improve the accuracy of examination results.At the same time,the stimulation of ophthalmic examination is often large,and some of them are even invasive operations,and due to the characteristics of ocular nerve anatomy,it is more sensitive to the stimulation,not only requires the children to cooperate with the simple sedation,but also to achieve a certain depth of sedation and analgesia.Esketamine is a new drug approved to be marketed in China recently.Compared with ordinary ketamine,esketamine has stronger analgesic effect,fewer side effects and faster onset time.It also has mild respiratory and circulatory excitatory effects,and the analgesic dose required is far less than the anesthetic dose.Compared with nystagmus,irritability,delirium and other adverse reactions frequently occurred in the use of high dose anesthesia,analgesia rarely occurred in the use of low dose.Dexmedetomidine is widely used in pediatric sedation management in recent years,but its analgesic effect is limited,easily awakened,when used alone often only be used for no invasive examination,and the potential of hemodynamic effects,especially its use in large doses,tend to have larger influence on heart rate,has certain security hidden danger,limiting its use in clinical.Combined with the different characteristics of the two drugs,the efficacy and safety of esketamine combined with dexmedetomidine intranasals in pediatric ophthalmic examination sedation are discussed,providing reference for clinical sedation in pediatric ophthalmic examination.Objective: To investigate the efficacy and safety of esticketamine combined with dexmedetomidine intranasals in sedation during pediatric ophthalmic examination Methods: A total of 120 children,aged 2-6 years,with ASA I ～ Ⅱ grade,who needed sedation before ophthalmic examination in the outpatient department or inpatient department of our hospital from June 2020 to October 2021 were selected.The children were divided into 3 groups by random number table method:Dexmedetomidine 2μg/kg+normal saline group(group D),esketron 0.25mg/kg+ dexmedetomidine 2μg/kg group(S1+ D group),esketron 0.5mg/kg+ dexmedetomidine 2μg/kg group(S2+D group),40 cases in each group.The above different doses of drugs were given nasal drops in the operation waiting area.After the children fell asleep,the anesthesiologist evaluated the Sedation depth according to the UMSS(University of Michigan Sedation Scale)Sedation score,and placed them on a flat car to the special examination room for eye examination when they reached 3 points.If the UMSS sedation score did not reach 3 points 30 minutes after intranasal administration,other drugs and methods should be used to remedy the situation.The first success rate of nasal drops,sedation onset time,examination time,resuscitation time of sedation,and the number of adverse events such as decreased heart rate,respiratory depression,nystagmus,nausea and vomiting,and delay of resuscitation were statistically analyzed in different groups.The quality of resuscitation was assessed by the resuscitation agitation(PAED)score,and sedation satisfaction was assessed by the examining physician using a 5-point digital satisfaction scale.Results: The first success rate of nasal drip,the effective time of sedation and the satisfaction degree of examiners in S1+D and S2+D groups were higher than those in GROUP D,and the recovery time of sedation in S1+D group was shorter than that in S2+D group(P < 0.05).Comparison within the three groups showed that the rate of heart rate decline at T1 was statistically significant compared with other times(P < 0.05),and pairwise comparison between groups showed that the frequency of heart rate decline in group D was higher than that in S1+D and S2+D,which was statistically significant(P <0.05).There was no statistical significance in other aspects.Conclusion:Esketamine 0.25mg/kg combined with dexmedetomidine 2μg/kg nasal drops had satisfactory sedation effect in pediatric ophthalmology examination,and it was a safe and effective sedation method with short resuscitation time,small adverse reactions,high quality of recovery and high satisfaction of the examination.