In children undergoing orofacial cleft surgery, giving dexmedetomidine (0.3 μg/kg) before extubation reduced emergence delirium more effectively than a ketamine-propofol mixture (ketofol) or saline. Delirium incidence was 20% with dexmedetomidine, 29% with ketofol, and 49% with saline. Pain scores were also lower with dexmedetomidine. Both sedatives outperformed saline, but dexmedetomidine provided the best prevention of postoperative delirium and pain.
In a randomized, double-blinded, placebo-controlled trial of 45 adults aged 18–60 with blunt chest trauma requiring noninvasive ventilation (NIV), dexmedetomidine produced significantly longer mean NIV session duration compared to placebo, but not compared to ketamine. Dexmedetomidine led to deeper sedation (lower Richmond Agitation Sedation Scale scores) than both ketamine and placebo. Ketamine provided better pain control (lower Visual Analog Scale scores) and required significantly less rescue morphine than the other groups. The findings suggest that while both sedatives improve NIV tolerance over placebo, each offers distinct advantages: dexmedetomidine for sedation and ketamine for analgesia with less opioid use.