Study of intranasal midazolam versus intranasal ketamine as a premedication in children undergoing surgical procedures
Keywords:Children, Intranasal ketamine, Intranasal midazolam, Premedication, Sedation, Induction
Background: Usage of premedication in children undergoing surgery is almost imperative and various medications have been used with varying success. The present study was aimed at comparison of intranasal midazolam and intranasal ketamine as a premedication in children by assessing acceptability of the drug by patients, ease at parent separation, level of sedation at the time of induction and facilitation of intravenous cannulation.
Methods: In this comparative observational study, 60 eligible participants were randomly divided into two groups of 30 each on the basis of preanaesthetic medication received: those intranasal midazolam group and intranasal ketamine group. At 30 minutes after intranasal dose, sedation, separation from parents and intravenous cannula acceptance was evaluated on four point score scale. Children were constantly observed for occurrence of possible adverse effects and the same were duly noted.
Results: The two groups were similar with respect to age, gender and body weight distribution. Twenty four patients (80%) in both ketamine and midazolam groups were observed to become drowsy, while 6 patients (20%) in ketamine group were asleep, compared to 0 patients in midazolam group (p=0.024). Thirteen (43.3%) patients from midazolam group had poor parenteral separation, as compared to 0 patients from ketamine group. And Comparison of intravenous cannula acceptance revealed the acceptance to be good in 26 (86.7%) patients in ketamine group as compared to 10 (33.3%) patients in midazolam group (p<0.001).
Conclusions: Ketamine when given in a dose of 5 mg/kg via intranasal route is better than midazolam given in a dose of 0.2mg/kg intranasally, as a premedication in children.
Kain ZN, Caldwell-Andrews AA. Preoperative psychological preparation of the child for surgery: an update. Anesthesiol Clin North Am. 2005;23(4):597-614.
Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. AMA Am J Dis Child. 1953;86(5):587-91.
Williams JG, Jones JR. Psychophysiological responses to anaesthesia and operation. JAMA. 1968;203(6):415-7.
Mitchell V, Grange C, Black A, Train J. A comparison of midazolam with trimeprazine as an oral premedication for children. Anaesthesia. 1997;52(5):416-21.
Pacifici GM. Clinical pharmacology of midazolam in neonates and children: effect of disease- a review. Int J Pediatr. 2014;2014:309342.
Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: a comparison of intranasal dexmedetomidine versus oral midazolam. Saudi J Anaesth. 2011;5(4):387.
Debnath S, Pande Y. A comparative study of oral premedication in children with ketamine and midazolam. Indian J Anaesth. 2003;47(1):45-7.
Gharde P, Chauhan S, Kiran U. Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair. Ann Card Anaesth. 2006;9(1):25.
American Society of Anesthesiologists (ASA) Physical Status Classification System. Available at: https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system. Accessed on 17 June 2019.
Henderson JM, Brodsky DA, Fisher DM, Brett CM, Hertzka RE. Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. Anesthesiology. 1988;68(5):671-5.
Wilton NC, Leigh J, Rosen D, Pandit U. Intranasal midazolam premedication in pre-school children. Anesthesia and Analgesia. 1988;67(2):260.
Diaz J. Intranasal ketamine preinduction of paediatric outpatients. Pediatri Anesth. 1997;7(4):273-8.
Weksler N, Ovadia L, Muati G, Stav A. Nasal ketamine for paediatric premedication. Can J Anaesth. 1993;40(2):119-21.
Weber F, Wulf H, Gruber M, Biallas R. S‐ketamine and s‐norketamine plasma concentrations after nasal and iv administration in anesthetized children. Pediatr Anesthe. 2004;14(12):983-8.