Supplementary Low - Dose Oral Ketamine Provides Better Parental Separation and Face Mask Acceptance

Abstract

Background: Anesthesia is stressful for children and parents. Although anxiolytics can keep children calm, side effects may exist. No single method shows a clear advantage in keeping the child calm and cooperative. This study aimed to test the efficacy and safety of adding a small dose ketamine to midazolam-based oral premedication on child-parents separation and acceptance of face mask. Methods: Eighty preschool children scheduled for elective surgeries were included. Patients were allocated into 2 groups: A control group (group C), patients received oral midazolam 0.5mg/kg, and a study group (group S), patients the same dose of midazolam in addition to ketamine 2mg/kg. Child reaction to parent separation and parent satisfaction was rated according to separation and satisfaction scores. Induction of anesthesia was carried out using Sevoflurane 6 Vol% in 100% oxygen via face mask; child’s acceptance of the mask was reported. Results: Group (S) children were more cooperative regarding parents separation and acceptance of the face mask than group (C) children (P=0.000&0.02) respectively. No child developed deep sedation in both groups and Sedation score was more satisfactory in group (S), with better parent satisfaction in the same group (p=0.008, P=0.03respectively). Conclusion: Adding a small dose oral ketamine to midazolambased premedication in preschool children proved to be a safe and effective technique in improving child -parent separation and pleasant face mask acceptance.