Intranasal Esketamine safe premedication for sedation in children

In March 2021, 34 CHD kids who needed premedication were enrolled. Esketamine intranasal administration was started at a dosage of 1 mg/kg. The dose for the following patient was either raised or decreased by 0.1 mg/kg, which was changed between each kid, depending on how well the preceding patient tolerated the sedation. A Ramsay Sedation Scale score of three or less and a Parental Separation Anxiety Scale score of two or less were considered successful sedations. The modified sequential approach was used to determine the necessary ED50 of esketamine. At 5-minute intervals following the administration of the medication, non-invasive measurements of blood pressure, heart rate, peripheral oxygen saturation, onset of drowsiness, and adverse responses were taken.

The key findings of this study were:

1. The 34 children who were recruited had an average age of 22.5 ± 16.4 (4–54) months and a mean weight of 11.2 ± 3.6 (5.5–20.5) kg; they were classified I-III by the American Society of Anesthesiologists.

2. In pediatric patients with CHD, the ED50 of intranasal S(+)-ketamine (esketamine) needed for preoperative sedation was 0.7 (95% confidence interval: 0.54-0.86) mg/kg, and the mean start time of sedation was 16.39 7.24 min.

3. There were no significant adverse effects, such as respiratory distress, nausea, or vomiting.

Reference:

Huang, J., Liu, D., Bai, J., & Gu, H. (2023). Median effective dose of esketamine for intranasal premedication in children with congenital heart disease. In BMC Anesthesiology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12871-023-02077-1