Comparison of intranasal midazolam versus intranasal ketamine for preoperative anesthetic sedation in pediatric patients

摘要

Introduction: During induction ofanesthesiaanxiety ofchildrenmay bereduced moreeffectively by sedative medication than parental presence. Keeping in view, the necessity ofreducing preoperativeanxiety and postoperative psychological problemin pediatric patients, this studywas conducted to comparetheefficacy and safety ofintranasalmidazolamversus intranasal ketaminefor preanestheticsedation in pediatric patients. Methods: Ninety patients scheduled for thesurgery lasting between 30 min and 120 min under generalanesthesia wererandomly divided into two groups:Group Apatients received intranasalmidazolam0.2 mg/kg as premedication (5 mg/mL ampoule), whereas Group Bpatients received intranasal ketamine 5 mg/kg as premedication (50 mg/mL vial). The primary outcome measures werethecomparison of degree ofsedation of intranasalmidazolamversus intranasal ketaminefor preanestheticsedation in pediatric patients by accessing parentalseparation,acceptance of face mask, venipuncturescore,and postoperativesedation, whereas thesecondary outcome measures werethecomparison ofsideeffects. The comparison of quantitativeand qualitative variables between the groups was done using the unpaired student's“t”-testand Chi-squaretest or Fisher'sexact test, respectively. Results: The percentage of patients in the ketamine group with parentalseparation score morethan 2 was significantly higherascompared to the midazolamgroup. Acceptance offace mask, responseto venipuncture, postoperativesedation,and postoperativesideeffects werecomparable between thetwo groups. Both groups have minimalsideeffects. Conclusions: Bothmidazolamand ketamine nasally arean effective pediatric premedication for sedationwithminimalsideeffects. Parentalseparationwas better in the ketamine group ascompared to the midazolamgroup.