DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20162197

A double blinded comparative study of oral premedication in children with midazolam alone or in combination with ketamine

Jyoti Magar, Manish B. Kotwani Kotwani, Suhas Kotak

Abstract


Background:Surgery and anaesthesia induction cause considerable emotional stress upon children. In children pre-anaesthetic medications are frequently administered as pharmacological adjunction to alleviate the stress and fear of surgery as well as to ease child-parent separation and promote a smooth induction of anaesthesia.

Methods: Prospective double blinded randomized comparative study of oral premedication in children with midazolam alone or combination of midazolam with low dose ketamine in the age group of 3-10 years undergoing surgical procedures under standardized general anesthesia.

Results:In group M success rate of satisfactory sedation was 68.99% as against 76.59% in group MK, whereas success rate of anxiolysis was 80.00% in group M compared to 93.33% in group MK. 93.32% children were easily separated from parents in M Group compared to 96.66% in MK group. Also 73.32% children co-operated for IV line insertion in M group as against 96.66% in group MK and 83.33% children showed better mask acceptance in M group compared to 93.33% in MK group.

Conclusions:From present study, it was concluded that addition of low dose of ketamine improves quality and success rate of satisfactory sedation, anxiolysis, parental separation, co-operation for IV line and mask acceptance.


Keywords


Sedation, Anxiolysis, Parental separation, Co-operation for IV line and mask acceptance

Full Text:

PDF

References


Steward DJ. Preoperative evaluation and preparation for surgery. In: Pediatric Anesthesia 4th Edition. Churchill Livingstone New York; 2002.

Rosenberg H, Goldberg M. Postoperative emotional responses. In: complications in anesthesiology. 2nd Edition. Lippincott Raven Publishers. Philadelphia; 1996.

Beeby DG, Hughes JO. Behaviour of unsedated children in the anaesthetic room. Br J Anaesth. 1980;52(3):279-81.

Wright KD, Stewart SH, Finley GA, Buffett-Jerrott SE. Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review. Behav Modif. 2007;31(1):52-79.

Davis PJ, Tome JA, McGowan FX, Cohen IT, Latta K, Felder H. Preanesthetic medication with intranasal midazolam for brief pediatric surgical procedures. Effect on recovery and hospital discharge times. Anesthesiology. 1995;82(1):2-5.

Sury MR, Cole PV. Nalbuphine combined with midazolam for outpatient sedation. An assessment in fibreoptic bronchoscopy patients. Anaesthesia. 1988;43(4):285-8.

Stanley TH. New routes of administration and new delivery systems of anesthetics. Anesthesiology. 1988;68(5):665-8.

McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J. Premedication of children with oral midazolam. Can J Anaesth. 1992;39(6):545-50.

Geldner G, Hubmann M, Knoll R, Jacobi K. Comparison between three transmucosal routes of administration of midazolam in children. Paediatr Anaesth.1997;7(2):103-9.

Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effects of i.m. and oral ketamine. Br J Anaesth. 1981;53(8):805-10.

Gutstein HB, Johnson KL, Heard MB, Gregory GA. Oral ketamine preanesthetic medication in children. Anesthesiology. 1992;76(1):28-33.

Cioaca R, Canavea I. Oral transmucosal ketamine: an effective premedication in children. Paediatr Anaesth. 1996;6(5):361-5.

Sekerci C, Donmez A, AteĊŸ Y, Okten F. Oral ketamine premedication in children (placebo controlled double-blind study). Eur J Anaesthesiol. 1996;13(6):606-11.

Bowdle TA, Radant AD, Cowley DS, Kharasch ED, Strassman RJ, Roy-Byrne PP. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology. 1998;88(1):82-8.

Gingrich BK. Difficulties encountered in a comparative study of orally administered midazolam and ketamine. Anesthesiology. 1994;80(6):1414-5.

Beebe DS, Belani KG, Chang PN, Hesse PS, Schuh JS, Liao JC, et al. Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children. Anesth Analg. 1992;75(6):880-4.

Lin YC, Moynihan RJ, Hackel A. A comparison of oral midazolam, oral ketamine and oral midazolam combined with ketamine as preanesthetic medication for pediatric outpatients. Anesthesiology. 1993;70:A1177.

Meursing AEEE. Psychological effects of anaesthesia in children. Curr Opin. Anaesthesiol. 1989;335-8.

Funk W, Jakob W, Riedl T, Taeger K. Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine versus midazolam or ketamine alone. Br J Anaesth. 2000;84(3):335-40.

Ghai B, Grandhe RP, Kumar A, Chari P. Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication. Paediatr Anaesth. 2005;15(7):554-9.

Foroutan A, Yazdanian F, Abdollah Panahipour A, Meraji SM, Givtaj N, Jafari A. Oral premedication for pediatric cardiac surgery: a comparison of midazolam, ketamine and midazolam plus ketamine. Iranian Heart Journal. 2007;8(4):17-23.

Kumar A, Shah ZA, Anuradha, Garg R, Nath MP. Comparative evaluation of ketamine, midazolam and combination of both as oral premedicants in children. J Anaesth Clin Pharmacol. 2009;25(4):449-53.