Comparative Study between Intranasal Midazolam and Ketamine as a Premedication in Pediatric Surgical Patients

Authors

  • Usma Jabeen Assistant Professor, Department of Anaesthesiology & Critical Care, GMC Rajouri, Jammu & Kashmir, India
  • Saba Wani Senior Resident, Department of Anaesthesiology & Critical Care, GMC Rajouri, Jammu & Kashmir, India
  • Mohammad Adil Senior Resident, Department of Anaesthesiology & Critical Care, GMC Rajouri, Jammu & Kashmir, India
  • Suhail Banday Assistant Professor, Department of Anaesthesiology & Critical Care, GMC Rajouri, Jammu & Kashmir, India

Keywords:

premedication, anxiety, midazolam, ketamine and intranasal

Abstract

Background: The preoperative period is a stressful event, especially in the pediatric patients. The goals of preanesthetic medication for children include allaying patient anxiety and facilitating the smooth induction of anaesthesia. For providing premedication to pediatric surgical patients, various drugs and many routes have been studied. Midazolam, a GABA receptor inhibitor, is the most commonly used sedative drug for premedication in children. It provides effective sedation, anxiolysis, and varying degrees of anterograde amnesia. Ketamine is a phencyclidine derivative that antagonizes the N-methyl D-aspartate (NMDA) receptor which produces sedation with a trance-like state, analgesia, and preserves upper airway muscle tone and respiratory drive. Intranasal route is one of the preferred route because of the ease of administration.
Aims & objectives: In this study, we compared the effects of intranasal midazolam and ketamine on preoperative sedation, parenteral separation, response to intravenous cannulation and mask acceptance in paediatric patients. Materials & Methods: Sixty children classified as ASA physical status I & II, aged between 2- 10 years, who were scheduled to undergo an elective surgeries, were enrolled for a prospective, randomized, and double-blind controlled trial. All of the children received intranasal premedication approximately 30 min before the induction of anaesthesia. Group M (n = 30) received 0.2 mg/kg of intranasal midazolam, and Group K (n = 30) received intranasal ketamine 5mg/kg. All of the patients were anesthetized with nitrous oxide, oxygen, and sevoflurane, administered via a face mask. Results: No significant differences were observed in demographic, hemodynamic, and respiratory parameters, however significant tachycardia was observed in the ketamine group. Intranasal ketamine results in more successful parental separation and yields a higher sedation score (3.87± 0.66) compared to midazolam group (2.62± 0.69) at 30 minutes, with negligible side effects. Venous cannulation and face mask acceptance was also better in the ketamine group with a significantly higher percentage of patients with satisfactory venous cannulation and face mask acceptance (p<0.05). Conclusion: Intranasal ketamine is superior in decreasing anxiety upon separation from parents and providing satisfactory conditions during mask induction and venous cannulation. No adverse effects of the premedication drugs were observed in any of the groups.

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Published

2021-10-20

How to Cite

Usma Jabeen, Saba Wani, Mohammad Adil, & Suhail Banday. (2021). Comparative Study between Intranasal Midazolam and Ketamine as a Premedication in Pediatric Surgical Patients. International Journal of Health and Clinical Research, 4(18), 410–414. Retrieved from https://ijhcr.com/index.php/ijhcr/article/view/4942

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