This study compared dexmedetomidine versus ketamine as regard sedation and anxiolysis produced by giving them through intranasal route to pediatric patients undergoing adenotonsillectomy. This study was double-blinded randomized comparative prospective interventional clinical study done in Ain Shams University Hospital (El Demerdash Hospital) on 76 pediatric patients who underwent adenotonsillectomy, and they were randomly allocated equally into two main groups; group D received 2 μg/kg intranasal dexmedetomidine and group K received 5 μg/Kg intranasal ketamine 30 min before the operation, and the aim of this study was to compare the efficacy of intranasal dexmedetomidine versus intranasal ketamine for anxiolysis and sedation to alleviate stress, agitation, and anxiety in children before general anesthesia and for promoting good level of sedation for them. Results of this study as regards sedation level that was assessed by modified Ramsay sedation score showed that there was statistically significant difference between both groups at 10, 20, and 30 min from intranasal application of the drug (P value < 0.05), the median (IQR) of sedation score at 10, 20, and 30 min preoperative in group D was (2 (2 – 2)), (3 (3 – 4)), (4 (4 – 5)) compared to (2 (2 – 3)), (3 (2 – 3)), (4 (3 – 4)) in group K respectively which revealed that there was better and effective sedation in group D more than in group K, this difference was statistically significant but clinically insignificant as both drugs produced an acceptable level of sedation and decreased the level of anxiety in children. Both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and time of onset of sedation, and also there was little decrease in heart rate and mean arterial pressure which is favorable during such surgeries; also, there was accepted level of cannulation and parental separation scores, and the parents were highly satisfied with the procedure and were grateful for us due to alleviating stress and anxiety from them and from their children.

/pdf/comparative-study-between-intranasal-dexmedetomidine-and-2rkkv8bgra.pdf

Comparative study between intranasal dexmedetomidine and intranasal ketamine as a premedication for anxiolysis and sedation before pediatric general anesthesia

BACKGROUND
Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied.


OBJECTIVE
To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery.


DESIGN
A prospective randomised double-blind trial.


SETTING
A tertiary teaching hospital.


PATIENTS
Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery.


METHODS
Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg-1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg-1 (Group K, n = 32) 30 min before surgery.


OUTCOMES MEASURED
The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (Heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted.


RESULTS
The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, -0.406; 95% CI, -0.621 to -0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, -0.374; 95% CI, -0.650 to 0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported.


CONCLUSION
Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery: A randomized controlled trial.

* Abbreviations:
 CF — : cystic fibrosis
 HCW — : health care worker
 OPS — : oropharyngeal swab

Early detection and treatment of bacterial infection is effective in slowing the progression of lung disease in cystic fibrosis (CF).1 It is recommended that a minimum of 4 samples are collected for bacterial culture annually.2 Approximately two-thirds of children with CF cannot routinely expectorate sputum3; therefore, samples, such as oropharyngeal swab (OPS), are used. With reduced hospital visits and increased telehealth consultations secondary to the severe acute respiratory syndrome coronavirus 2 pandemic, the number of samples available for analysis has been severely impacted.4 Therefore, alternative methods of obtaining OPS are needed. One option is parental collection … 

Address correspondence to Michael Doumit, Department of Health Professions, Macquarie University, Talavera Rd, Macquarie Park, New South Wales, Australia 2109. E-mail: michael.doumit{at}mq.edu.au

Parent-Collected Oropharyngeal Swabs in Cystic Fibrosis

Advances in molecular laboratory techniques are changing the prospects for the diagnosis of viral infectious diseases. Multiplex polymerase chain reaction assay (multiplex-PCR) can detect dozens of pathogens simultaneously, greatly reducing turnaround time (TAT) and improving detection sensitivity. But as a double-edged sword, due to the high sensitivity of PCR, the type of respiratory specimens is critical to diagnosis. In this work, we performed a head-to-head comparison to evaluate the multiplex-PCR yields between two samples, sputum and flocked oropharyngeal swabs (OPS). Eleven common respiratory pathogens were tested in hospitalized children< 13 years of age who met the criteria for lower respiratory tract infection by GeXP-based multiplex-PCR of paired OPS and sputum. From January to June 2018, 440 children with paired OPS and sputum were tested. The positive rate was 84% (369/440) for OPS and 88% (386/440) for sputum (p = .007). The frequency of detection of HRV, RSV, Influenza A virus, HMPV, parainfluenza virus, adenovirus, M. pneumoniae, coronavirus, bocavirus and C. pneumoniae in sputa was higher than that of OPSs (all p < .001). Both types of specimens had similarly very good kappa values for most of pathogens, except for Mycoplasma pneumonia (κ = 0.61) and Chlamydia pneumoniae (κ = 0.24). Additionally, 79.3% (349/440) of cases showed consistent results between the two types of samples, and they were significantly younger than patients with inconsistent results (p = .002). Flocked oropharyngeal swabs and sputum performed similarly for the detection of common respiratory pathogens in hospitalized children by multiplex-PCR, except for Mycoplasma pneumoniae and Chlamydia pneumoniae. Young patients are likely to have consistent results between the two specimens.

/pdf/comparing-the-yield-of-oropharyngeal-swabs-and-sputum-for-4d4lu90bvq.pdf

Comparing the yield of oropharyngeal swabs and sputum for detection of 11 common pathogens in hospitalized children with lower respiratory tract infection.

pdf/intranasal-dexmedetomidine-2mg-kg-versus-3mg-kg-on-parent-1a2m9899t0.pdf

INTRANASAL DEXMEDETOMIDINE 2μG/KG VERSUS 3μG/KG ON PARENT SEPARATION IN DENTAL SURGERY: A RANDOMIZED CLINICAL TRIAL

Background Oropharyngeal suction and oropharyngeal swab are two methods of obtaining airway samples with similar diagnostic accuracy in children with cystic fibrosis (CF). The primary aim was comparing distress between suctioning and swabbing. A secondary aim was establishing the reliability of the Groningen Distress Rating Scale (GDRS). Methods Randomised oropharyngeal suction or swab occurred over two visits. Two physiotherapists and the child’s parent rated distress using the GDRS. Heart rate (HR) was also measured. Results 24 children with CF, mean age of 3 years, participated. Both physiotherapist and parent rating showed significantly higher distress levels during suction than swab. Inter-rater reliability for the GDRS was very good between physiotherapists, and good between physiotherapist and parents. Conclusion The study found that oropharyngeal swab is less distressing in obtaining samples than oropharyngeal suction and that the GDRS was reliable and valid.

https://adc.bmj.com/content/archdischild/104/8/806.full.pdf

Distress during airway sampling in children with cystic fibrosis.

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Distress during airway sampling in children with cystic fibrosis.