Comparison of Intra Nasal Midazolam Versus Ketamine as Premedication in 2-5 Years old Paeditric Surgery Patients

摘要

Background and Aim: Surgery and anesthesia can cause considerable distress and psychological consequences for children. In children, preanesthetic medications are frequently administered as pharmacologic adjuncts to help alleviate the stress and fear of surgery as well as to ease child-parental separation and promote a smooth induction of anesthesia. Oral, rectal, intravenous and intramuscular preanesthetic medication administration have been used. However, each route has disadvantages. Pre anaesthetic medication administered nasaly, due to its rapid and reliable onset of action, avoidance of painful injections and ease of administration have made it a convenient way to premedicate children. The aim of the present study is to compare the sedative effect of ketamine and midazolam administered nasaly as premedication. Patients and Methods: 130 children aged 2-5 years and with ASA class I-II randomly allocated in three groups and 20 minutes before operation time received either 0.2mg/kg midazolam or 5mg/kg ketamine or 2ml normal saline, intranasally. After administration of intranasal premedication the children were under direct observation of anesthesiology resident near their parents. At the time of separation and at the time of IV line insertion, on the basis of Sury and Cole sedation score they received a sedation score. Results: According to statistical analysis, at the time of separation from parents in midazolam group, 90% of patients were sedated (60% had mild sedation, 30% had good sedation), in ketamine group, 89% were sedated (32.5% had mild sedation, 59.5% had good sedation) while in placebo group, 47.5% showed sedation (40% mild, 7.5% good). At the time of intra venous line insertion, in midazolam group, 86% of patients were sedated (56% had mild sedation, 30% had good sedation), in ketamine group, 80% were sedated (57.5% had mild sedation, 22.5% had good sedation) while in placebo group 22.5% (20% had mild sedation, 2.5% had good sedation) showed sedation. Conclusion: On the basis of results midazolam and ketamine administered intra nasaly are effective in inducing sedation. Comparing these drugs with placebo, they are effective adjunctive premedicant.