Comparison of oral Midazolam versus Combination of Low Dose Oral Midzolam–Ketamine for Premedication in Paediatric Surgical Patients

Abstract

Background and need for study: One of the challenge faced by paediatric anaesthesiologist is the allaying of fear of a child in the preoperative period. Among the commonly used premedicant in children, midazolam is the front runner. A combination low dose of ketamine and midazolam have been tried to overcome the deficiencies of ketamine and midazolam alone. Aims: This research was planned to compare the effectiveness of combination of low dose midzolam–ketamine with oral midazolam alone as a premedicant in paediatric patients in terms of degree of sedation, separation from parents, mask acceptance, and postoperative recovery Design: Prospective, randomised, double blind controlled study. Methods: Sixty children of ASA physical status I or II, aged between 1 and 12 years, who were scheduled to undergo elective minor surgery were randomised into two groups M and MK of thirty children each. Children in group M were administered with oral midazolam 0.5 mg.kg-1 mixed with 2 ml of honey and group MK were administered with combination of low dose oral midzolam (0.25 mg.kg-1) & oral ketamine (3 mg.kg-1) for premedication mixed with 2 ml of honey. Patient was assessed for parental separation anxiety, mask acceptance, level of sedation and emergence delirium. Statistical Analysis: Difference with respect to anxiety at separation from parents and tolerance to mask between the two groups was analysed using chi-square test . Difference with respect to incidence and severity of emergence delirium between the two groups was analysed using an independent sample t test . The P <0.05 was considered significant. Results: Parental separation was acceptable in 23 patients (76.7%) in group M and 28 patients in (93.3%) in group MK (Table 2, 3). Mask acceptance was satisfactory in 13 (43.3%) in group M and 19(63.3%) in group MK. Post-operative delirium was noted in one patient in each group. Conclusion: The low dose mixture of ketamine and midazolam provides better parental separation and mask acceptance with better cooperation during induction of anaesthesia.