Background: Smooth preoperative separation, hemodynamic steadiness, and rapid, calm recovery are central goals in pediatric anesthesia. Dexmedetomidine (D) may complement ketamine (K) by attenuating sympathetic tone without respiratory depression. We compared ketamine alone, dexmedetomidine alone, and their combination (KD) in children. Materials and Methods: In this single-center randomized, three-arm trial, 96 children (32 per group) undergoing elective ophthalmology procedures under general anesthesia were allocated to K, D, or KD. Preoperative hemodynamics were recorded at 0, 15, and 30 minutes; sedation and separation were assessed at 30 minutes using the Five-Point Sedation Scale (FPSS) and the Parental Separation Anxiety Scale (PSAS). Intraoperative vitals (0/15/30 minutes) and recovery outcomes—Emergence Agitation Score (EAS) and time to an awake, easily arousable state FPSS—were collected. Group differences used Welch ANOVA or Kruskal–Wallis as appropriate, with prespecified change-from-baseline and area-under-the-curve (AUC) summaries. Results: Groups were balanced for age/sex and baseline vitals, except for a modestly higher baseline heart rate in K. Preoperatively, FPSS medians were similar across arms (all 3 3–4, but PSAS favored D and KD over K (K 3 3–4, D 2 2–3, KD 2 2–3; omnibus P < 0.001). Intraoperatively, D and KD maintained lower heart rate and mean arterial pressure than K at 15 and 30 minutes (all omnibus P < 0.001), while respiratory rate and SpO₂ were stable and comparable between groups. Recovery outcomes aligned with these patterns: EAS was lowest with KD, intermediate with D, and highest with K; time to FPSS (mean ± SD) was 1.562 ± 0.669 min (K), 1.468 ± 0.567 min (D), and 1.375 ± 0.491 min (KD) (omnibus P < 0.001). AUC and Δ-from-baseline analyses corroborated lower cumulative cardiovascular load with D/KD. No desaturation events were observed; adverse events were not systematically captured. Conclusions: Compared with ketamine alone, dexmedetomidine—alone or combined with ketamine—facilitated easier parental separation, steadier intraoperative hemodynamics without respiratory compromise, and faster, calmer recovery. When smooth separation and efficient early recovery are priorities, D or KD appears advantageous. Confirmation with standardized adverse-event reporting and multicenter designs is warranted.
Kumar et al. (Thu,) studied this question.