Comparative study between oral midazolam and oral ketamine as preanaesthetic medication in paediatric patients undergoing elective surgery: a randomized double blind study

Hachio William M Yanthan ,Tridip Jyoti Borah ,Subrata Pahari ,Tirtha Ghosh ,Jaideep Sonowal

doi:10.18231/2394-4994.2018.0036

Abstract

Introduction: Prime objective of anaesthesiologist is to minimize adverse psychological and physiological effects of anaesthetic technique. Premedication causes sedation and reduction of anxiety during separation from parents. It also provides a calm and cooperative child for smooth induction of anesthesia. We evaluated the differences in quality of premedication with orally administered midazolam and ketamine in the paediatric population undergoing elective surgical procedures and tried to ascertain the minimum interval required between premedication and parental separation. Objective: This study was undertaken to compare the efficacy and safety of oral midazolam and oral ketamine as a preanaesthetic medication for paediatric patients undergoing elective surgery. Materials and Methods: In this prospective, randomized, double blind study a total of 60 children aged 1-6 years, belonging to ASA grade 1 and 2, scheduled for elective surgery were randomized into two groups of 30 each to receive either midazolam 0.5 mg/kg (Group A) or ketamine 5 mg/kg (Group B) orally. Parameters to be assessed were quality of sedation and anxiolysis, ease of parent-child separation and ease of venepuncture. Results: Overall success rate of midazolam for sedation and anxiolysis was higher than ketamine in all the time frames. Successful separation from parents was easy in 25 patients (83.33%) in group A and 13 patients (43.33%) in group B. Successful venepuncture was obtained in 93.33% and 90% of patients in group A and group B respectively. This higher rate of success during venepuncture was probably due to use of EMLA cream prior to venepuncture. Conclusion: We concluded that premedication with oral midazolam 0.5mg/kg provides better sedation and anxiolysis, easy parent child separation than oral ketamine 5mg/kg. Keywords: Midazolam, Ketamine, Preanaesthetic, Anxiolysis, Venepuncture.

Highlights

Prime objective of anaesthesiologist is to minimize adverse psychological and physiological effects of anaesthetic technique
The aim of this study was to evaluate the differences in quality of premedication with orally administered midazolam and ketamine in the paediatric population undergoing elective surgical procedures and ascertain the minimum interval required between premedication and parental separation
Patients with known history of allergies to benzodiazepines and ketamine, central nervous system dysfunction –epilepsy or raised intracranial tension, cardiovascular malformation, respiratory dysfunctions such as COPD, asthma, chronic bronchitis, prolonged therapy with hepatic enzyme – inducing drugs, children refusing to take the whole dose of premedication were excluded from the study

Summary

Introduction

The anticipation of pain, separation from family, and fear of surgery are few of the factors that trigger perioperative anxiety in children.[1,2,3] Prime objective of anaesthesiologist is to minimize adverse psychological and physiological effects of anaesthetic technique.[4] Premedication causes sedation and reduction of anxiety during separation from parents. It provides a calm and cooperative child for smooth induction of anesthesia

Objectives

Methods

Results

Conclusion