Oral Premedication in Paediatric Surgeries under General Anaesthesia with Ketamine versus Midazolam: A Comparative Study
Journal Title: Indian Journal of Anesthesia and Analgesia - Year 2018, Vol 5, Issue 4
Abstract
Background: Pre-operative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgical experience (e.g. agitation, crying, spontaneous urination and the need for physical restraint during anaesthetic induction). Pre-operative anxiety has also been associated with the display of a number of maladaptive behaviourspost surgery, including post-operative pain, sleep disturbances, parent-child conflict and separation anxiety [1]. The risk factors associated with high incidence of perioperative anxiety in children include shy and inhibited nature, previous poor quality medical encounters, poor social adaptability and increased parental anxiety [1]. If children are less anxious during the peri-operative period, not only will they often exhibit less behavioral disturbances post-operatively, but they may face subsequent medical care more easily [2]. Thus, there are several compelling reasons to treat children’s anxiety preoperatively. The aim of our study was to compare the efficacy and safety of oral midazolam versus oral ketamine for pre-medication in paediatric surgeries under general anaesthesia. Materials and Methods: Sixty children belonging to ASA physical status I as outlined by the American Society of Anaesthesiologists (ASA) of either gender were included in the study. They were randomly divided into two groups of 30 children in each group, group A and group B. Group A patients received 0.5mg/kg of oral midazolam as a premedicant 45 minutes before induction and Group B patients received 6mgs/kg of oral ketamine as a premedicant 45 minutes before induction. Time of onset of sedation and sedation score at 30 minutes were noted. Anxiety score at separation from parents, room air saturation, response to pre-oxygenation, side effects, if any, preoperatively and postoperatively were also noted. Results: In our study, the mean time of onset of sedation was lower with ketamine group (19.48 minutes) as compared to the midazolam group (25.63). The sedation score at 30 minutes and anxiety score at separation from parents were also satisfactory. In our study we found that the mean sedation score at 30 minutes was 1.9 with ketamine group and 3.03 in midazolam group.The mean anxiety score at separation was 1.8 with ketamine group and 2.53 in midazolam group. All patients allowed calm separation from parents. Conclusion: It is concluded that ketamine at a dose of 6 mgs/kg orally provides better sedation and anxiolysis in children with minimal side effects than oral pre-medication with midazolam at the dose of 0.5 mg/kg.
Authors and Affiliations
Geetanjali S.
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- EP ID EP535485
- DOI 10.21088/ijaa.2349.8471.5418.9
- Views 101
- Downloads 0
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