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Comparison of oral Midazolam with Ketamine versus oral Midazolam as a premedication in children

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Original Article

Author Details : Sonal S. Khatavkar, Trupti P. Deshpande, Sameer Zayed, Manoj Zingraji Misal, Pranita Kate

Volume : 3, Issue : 2, Year : 2016

Article Page : 66-72

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Abstract

In paediatric patients midazolam and ketamine are commonly used as premedicants. This prospective randomized study was conducted to compare the efficacy of oral midazolam versus combination of midazolam and ketamine as premedicants in paediatric age group in 60 childrens. 30 in each group, aged 2-6 years, undergoing major and intermediate surgery were included in the study. Forty five (45) minutes prior to surgery group A received oral midazolam (0.5mg/kg) and group B received oral midazolam 0.25mg/kg and oral ketamine (3mg/kg) in recovery room.
The observations included onset of sedation, reaction to emotions, sedation score, response to intravenous cannulation and face mask acceptance. The data was analysed using chi-square test and unpaired t-test. The results observed in midazolam and ketamine group were statistically significant than in midazolam group alone. Intraoperatively, haemodynamic parameters were comparable in both the groups. There was significant post-operative analgesia in midazolam and ketamine (M+K) group.
Thus we conclude oral premedication allays anxiety significantly and results in a calm and co-operative patient. Midazolam as well as midazolam and ketamine (M+K) offers sedation of superior quality. No significant side effects were observed in both the groups.
Aims: Midazolam and Ketamine are used in children commonly for premedication. Aim of our study was to find premedicant effects of oral midazolam and midazolam with ketamine in children and any advantages of combination of oral midazolam with ketamine.
Methods and Material: Sixty children of age group 2–6 years of A.S.A grade 1and 2 were selected.
Group A-midazolam [0.5mg/kg]
Group B- midazolam [0.25 mg/kg + ketamine 3mg/kg]
Both groups received drug orally 45min before surgery in recovery room with monitored anesthesia care. Onset of sedation, reaction to emotions, score of sedation, mask acceptance and intravenous cannula acceptance were studied.
Statistical analysis used: Chi square test and Unpaired t-test.
Results: Sedation score, anxiolysis, attitude, reaction to Intravenous cannulation, face mask acceptance, reaction to emotions were studied in both groups. Midazolam and ketamine group results were significant than midazolam group. Intra operatively in both groups pulse rate, oxygen saturation, respiratory rate had no significant difference also post operatively no significant difference was observed in above parameters, post-operative analgesia was significantly better in midazolam with ketamine group.
Conclusions: Oral premedication provides good pre-operative condition in terms of co-operation and anxiety. Midazolam as well as combination of Midazolam with ketamine offers sedation of superior quality. No significant side-effects were observed in both groups.

Key-words: Pediatric anesthesia, Oral midazolam, Ketamine.
Key Messages: Oral premedication is easily acceptable by children and allows predictable sedation in children. Midazolam with ketamine offers superior quality of sedation and separation reaction as compared to midazolam

 

How to cite : Khatavkar S S, Deshpande T P, Zayed S, Misal M Z, Kate P, Comparison of oral Midazolam with Ketamine versus oral Midazolam as a premedication in children. Int J Pharm Chem Anal 2016;3(2):66-72

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