Dexmedetomidine and ketamine combo has safe and effective sedo-analgesic effect

The purpose of sedation in certain mechanically ventilated patients has traditionally been to keep them calm and comfortable in order to optimise the patient's endotracheal tube tolerance and ventilator synchronisation while undergoing elective post-operative ventilation following major surgery. Inadequate sedation may cause undesirable anxiety, agitation, ventilator asynchrony, and recall in the post-ICU period, hence increasing morbidity. In the critical care unit, titration of analgesics and sedatives is required for every patient. A recently published research compared dexmedetomidine and ketamine in sedoanalgesia for post-operative mechanical breathing after major oncological surgeries.

Randomly, 60 adult surgery patients were assigned into two groups. Group KD (n = 30) got dexmedotomidine combined with ketamine at a rate of 0.5 g/kg/h, whereas Group DEX (n = 30) received dexmedotomidine at a rate of 0.5 mg/kg/h alone. Dexmedetomidine- 0.2-0.7 g/kg/h and ketamine- 0.2-0.7 mg/kg/h were titrated in both groups to achieve the desired sedation. The recording of hemodynamic data, pain ratings, sedation scores, and patient satisfaction. At 2 h and 4 h, pain ratings in the DEX group were significantly greater than in the KD group, which was statistically significant (P 0.05). At the end of 2 hours, the KD group had significantly greater sedation ratings than the DEX group (P 0.05). The ketamine-dexmedetomidine group required shorter time to achieve tracheal extubation than the dexmedetomidine group. Nevertheless, the difference was not statistically significant.

By mixing dexmedetomidine with ketamine, the incidence of hypotension and bradycardia was reduced. The combination of dexmedetomidine and ketamine might be used safely and efficiently as a sedoanalgesic. Dexmedetomidine is a newly produced alpha-2 agonist that has much better selectivity for the 2-adrenoceptor than other commonly used agonists (e.g., clonidine). Ketamine is a dissociative drug that detaches the central nervous system from external stimuli. It offers superior analgesia, sedation, and forgetfulness while maintaining airway reflexes, respiratory effort, and cardiovascular stability. Combination treatment with dexmedetomidine and ketamine is safe and effective for sedation and analgesia in postoperative ICU patients who need elective ventilation assistance. There was a decrease in the incidence of bradycardia and hypotension.

Reference -

Gupta, Bikram K.; Mhaske, Vanita R.1; Pai, Vishal Krishna2; Mishra, L.D., A comparative study of sedo-analgesic effect of dexmedetomidine and dexmedetomidine with ketamine in postoperative mechanically ventilated patients, Journal of Anaesthesiology Clinical Pharmacology: Jan–Mar 2022 - Volume 38 - Issue 1 - p 68-72

doi: 10.4103/joacp.JOACP_234_19