Oral preanesthetic medication for Children : a comparison of midazolam, Ketamine and midazolam plus ketamine

ABSTRACT: The study was aimed at finding a suitable premedicant which facilitates induction of anesthesia without causing significant undesirable side effects. Sixty children of ASA grade I and II, aged between 3 and 8 years were enrolled randomly in observer-blinded fashion into 3 different groups in equal numbers (n=20). Each group received midazolam (0.5 mg/kg) or ketamine (5 mg/kg) or combination of midazolam (0.25 mg/kg) plus ketamine (2.5 mg/kg) per orally, 30 minutes before induction of anesthesia. Children were evaluated preoperatively for the acceptance of the premedicants, sedation, separation from parents, response to intravenous cannulation and acceptance of face mask. There were no statistically significant differences with reference to the above mentioned parameters, in the 3 groups of patients. Some differences however, were noticed. The combination of midazolam plus ketamine provides good acceptability and predictable sedation within 30 minutes of administration. Smooth separation from the parents was not seen in this group. Intravenous cannulation was significantly uneventful (P0.05) with midazolam. Mask acceptance was better with midazolam or ketamine given alone. The incidence of side effects like nystagmus (50 percent) was higher with ketamine given along. No respiratony distress, tachycadia or poor arterial saturation was noted perioperatively in all 3 groups. We conclude that midazolam 0.5 mg/kg or combination of midazolam 0.25 mg/kg plus ketamine 2.5 mg/kg provides better premedication in children than ketamine 5 mg/kg when given orally 30 minutes before the induction of anesthesia.