Comparison of intranasal midazolam versus intranasal ketamine for preoperative anesthetic sedation in pediatric patients

Abstract

Introduction: During induction of anesthesia anxiety of children may be reduced more effectively by sedative medication than parental presence. Keeping in view, the necessity of reducing preoperative anxiety and postoperative psychological problem in pediatric patients, this study was conducted to compare the efficacy and safety of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients. Methods: Ninety patients scheduled for the surgery lasting between 30 min and 120 min under general anesthesia were randomly divided into two groups: Group A patients received intranasal midazolam 0.2 mg/kg as premedication (5 mg/mL ampoule), whereas Group B patients received intranasal ketamine 5 mg/kg as premedication (50 mg/mL vial). The primary outcome measures were the comparison of degree of sedation of intranasal midazolam versus intranasal ketamine for preanesthetic sedation in pediatric patients by accessing parental separation, acceptance of face mask, venipuncture score, and postoperative sedation, whereas the secondary outcome measures were the comparison of side effects. The comparison of quantitative and qualitative variables between the groups was done using the unpaired student's “t”-test and Chi-square test or Fisher's exact test, respectively. Results: The percentage of patients in the ketamine group with parental separation score more than 2 was significantly higher as compared to the midazolam group. Acceptance of face mask, response to venipuncture, postoperative sedation, and postoperative side effects were comparable between the two groups. Both groups have minimal side effects. Conclusions: Both midazolam and ketamine nasally are an effective pediatric premedication for sedation with minimal side effects. Parental separation was better in the ketamine group as compared to the midazolam group.