COMPARATIVE EVALUATION OF MIDAZOLAM AND KETAMINE WITH MIDAZOLAM ALONE AS ORAL PREMEDICATION IN CHILDREN”

Shreya Modi; Dr Subhash Patel

doi:10.55489/njmr.13012023938

Authors

Shreya Modi Surat Municipal Institute of Medical Education & Research, Surat, India
Subhash patel Surat Municipal Institute of Medical Education & Research, Surat, India

DOI:

https://doi.org/10.55489/njmr.13012023938

Keywords:

Midazolam, ketamine, Pediatric, premedication

Abstract

Introduction: The main aims of preanesthetic medication in children are to reduce anxiety associated with the unfamiliar environment, facilitate the separation of the child from their parent and allow smooth induction of an-esthesia. Both oral midazolam and oral ketamine fulfil many of these char-acteristics and are useful.

Method: As 48 patients of ASA grade 1 and 2, aged between 2-10 years un-dergoing elective surgery were allocated to one of two study groups using random numbers: Group 1 received midazolam 0.5mg/kg and group 2 re-ceived midazolam 0.25 mg/kg with ketamine 3 mg/kg. The medications were prepared and mixed with 25% dextrose up to a maximum volume of 0.3 ml/kg.

Result: Uniform and acceptable sedation scores were seen in both the groups, without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were eas-ily separated from their parents. The induction scores, Recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups.

Conclusion: Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more Benefits.

References

Saarnivaara, Lindgren L, Klemola Um. Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery. Br J Anaesth 1988; 61:390-396. Doi: https://doi.org/10.1093/bja/61.4.390 PMid:3190970

Feld LH, Negus JB, White PF. Oral midazolam preanesthetic medication in pediatric outpatients. Anesthesiology 1990; 73:831-834. Doi: https://doi.org/10.1097/00000542-199011000-00006 PMid:2240672

Rowbottam SJ, Stewart KG, Sudhaman DA, Aitken AW. Oral ketamine. Anaesthesia 1991; 46:1084-1085. Doi: https://doi.org/10.1111/j.1365-2044.1991.tb09936.x PMid:1815569

Gutstein HB, Johnson KL, Heard MB, Gregory GA. Oral ketamine preanesthetic study in children. Anesthesiology 1992; 76:28-33. Doi: https://doi.org/10.1097/00000542-199201000-00004 PMid:1729932

Gingrich BK. Difficulties encountered in a comparative study of orally administered midazolam and ketamine. Anesthesiology 1994; 80:1414-1415. Doi: https://doi.org/10.1097/00000542-199406000-00046 PMid:8010498

Beebe DS, Belani KG, Chang PN et al. Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children. Anesth Analg 1992; 75:880-884. Doi: https://doi.org/10.1213/00000539-199212000-00003 PMid:1443705

Warner DL, Cabaret J, Velling D. Ketamine plus midazolam, a most effective paediatric premedicant. Paediatr Anesth 1995; 5:293-295. Doi: https://doi.org/10.1111/j.1460-9592.1995.tb00307.x PMid:7489470

V. Darlong, D. Shende, M. S. Subramanyam, R. Sunder, A. Naik Oral Ketamine or Midazolam or Low Dose Combination for Premedication in Children Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India Anaesth Intensive Care 2004; 32: 246-249 Doi: https://doi.org/10.1177/0310057X0403200214 PMid:15957724

Epstein RH, Mendel HG, Witkowski TA et al. The safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children. Anesth Analg 1996; 83:1200-1205. Doi: https://doi.org/10.1213/00000539-199612000-00012 PMid:8942586

Cioaca R, Canavea I. Oral ketamine preanaesthetic premedication in children. Paediatr Anaesth 1996; 6:361-365. 11. Doi: https://doi.org/10.1046/j.1460-9592.1996.d01-9.x PMid:8880815

Bevan JC, Veall GR, Macnab AJ, Ries CR, Marsland C. A comparison of midazolam with trimeprazine as an oral premedicant for children. Anaesthesia 1997; 52:416-421. 12. Doi: https://doi.org/10.1111/j.1365-2044.1997.120-az0122.x PMid:9165958

Midazolam premedication delays recovery after propofol without modifying involuntary movements. Anesth Analg 1997; 85:50-54. Doi: https://doi.org/10.1213/00000539-199707000-00009 PMid:9212121

Alderson PJ, Lerman J. Oral premedication for paediatric ambulatory anaesthesia: a comparision of midazolam and ketamine. Can J Anaesth 1994; 41:221-226. Doi: https://doi.org/10.1007/BF03009834 PMid:8187256

Lin YC, Moynihan RJ, Hackel A. A comparison of oral midazolam, oral ketamine and oral midazolam combined with ketamine as preanaesthetic medication for paediatric outpatients. Anesthesiology 1993; 79:A1177

McMillan CO, Spahr-Schopfer IA, Sikich N et al. Premedication of children with oral midazolam. Can J Anaesth 1992; 39:545-550. Doi: https://doi.org/10.1007/BF03008315 PMid:1643676

Cetina J. Schonende Narkoseeinleitung bei Kindern durch orale oder rektale Ketamin-Dehydrobenzperidol-Applikation Anaesthesist 1982; 31: 277-9

Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effect of IM and oral ketamine. Br J Anaesth 1981; 53: 805-9. Doi: https://doi.org/10.1093/bja/53.8.805 PMid:7272143