Abstract
Background: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful for oral premedication in children to allay anxiety, allow separation from parents and to ensure smooth induction.Methodology: It was a prospective, randomized, double-blinded and comparative study conducted in 80 children of ASA I and II aged 1-6years undergoing elective ophthalmological procedures under general anesthesia. Children were randomized and divided into two groups, K received 4mg/kg of Ketamine and MK received 0.2mg/kg of Midazolam+2mg/kg of Ketamine peroral. Sedation level, ease of parental separation and ease of mask acceptance were evaluated within 20-30 minutes on a 4-point scale. The time to achieve modified Aldrete score of ≥9 was also noted.Results: Two groups were identical regarding age, sex, weight and ASA status. In sedation score, 31(77.5%) children in group K and 35(87.5%) children in group MK were awake, calm and quite (score3)(p=0.50). In parental separation score, 34(85%) children in group MK and 25(62.5%) children in group K have good separation, awake and calm (score2) (p=0.04). In mask acceptance score, 34(85%) children in group MK and 17(42.5%) children in group K were calm, awake, cooperative, accepting Mask (score1)(p=0.001). Time of recovery in group K was 17.92}6.50min whereas in group MK was 17.80}4.059min(p=0.91).Conclusion: Ketamine 4mg/kg and combination of Midazolam 0.2mg/kg with Ketamine 2mg/kg are equally effective but low dose combination is safe and superior. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 66-73
Highlights
Surgery and anesthesia procedure produce considerable emotional stress on children and parents.[1]
When the children are separated from their parents, fears of injections, operation, peculiar operation theatre environment and physicians invariably produces traumatic experiences in young children.[2]
Premedication is used in children to facilitate anxiety-free and smooth separation from the parents and smooth induction of anesthesia
Summary
Surgery and anesthesia procedure produce considerable emotional stress on children and parents.[1]. In 2000 A.D., Funk et al[5] had considered low success for awake state, but in 2005 Ghai B et al[6] considered excellent for awake state as long as there is good anxiolysis allowing successful separation They accepted calm, quiet and awake child as a good result because it avoids loss of head control or balance, loss of airway control and hypoxemia, etc. Ketamine has been investigated as an alternative oral premedicant because after oral administration it has similar pharmacodynamics It has been used as a sedation medication in doses of 5 to 6 mg/kg for 1 to 6 years children.[8] Maximal sedation occurred within 20 minutes. This study was designed to compare efficacy of a combination of oral ketamine 2 mg/kg and midazolam 0.2 mg/kg with ketamine 4 mg/kg alone for achieving calm, quiet and awake child allowing smooth parental separation, accepting mask and having minimal recovery time
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