A Comparative study between Nebulized Ketamine, Nebulized Dexmedetomidine and Topical Lidocaine as Premedications for Flexible Fiberoptic Bronchoscopy in Pediatrics

Abstract

Flexible fiberoptic bronchoscopy remains an invaluable tool in the evaluation and management of infant and pediatric respiratory disease. Anesthetic strategies in pediatric fiberoptic bronchoscopy should aim at minimizing respiratory complications as oxygen desaturation, hypoxemia, cough, bronchospasm and airway trauma. Preprocedural sedation is of great importance in children undergoing bronchoscopic procedures to alleviate anxiety, minimize separation anxiety and allow for smooth induction of anesthesia. An ideal premedication is one that provides satisfactory sedation in addition to minimizing such complications. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has dissociative anesthetic effects and analgesic properties in sub anesthetic doses. Moreover, ketamine at high doses has local anesthetic properties; these may be through its ability to inhibit neuronal sodium channels. Dexmedetomidine (DEX) is a highly selective α2 adrenergic receptor agonist. Previous studies have reported that dexmedtomidine could be safely and effectively used for bronchoscopic procedures. Administration of dexmedetomidine through inhalational route could be a new promising noninvasive method.