Intranasal Esketamine safe premedication for sedation in children

A new study published in BMC Anesthesiology suggests that esketamine administered intranasally had an effective dose (ED50) of 0.7 mg/kg, which was both safe and efficient for sedating young patients with congenital heart disease (CHD) prior to surgery.

Esketamine's sedative effects make it a popular premedication. For children with congenital heart disease, the ideal dose for intranasal usage has not yet been established. In order to determine the median effective dose of esketamine for intranasal premedication in children with CHD, Jiajia Huang and colleagues did this study.

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