Comparative Study between Intranasal Midazolam and Ketamine as a Premedication in Pediatric Surgical Patients
Keywords:
premedication, anxiety, midazolam, ketamine and intranasalAbstract
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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Copyright (c) 2022 Usma Jabeen, Saba Wani, Mohammad Adil, Suhail Banday

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