Placebo controlled comparative study of oral midazolam and oral ketamine as a premedication in paediatric age group

Authors

  • Somnath Longani Department of Anaesthesia and Critical Care, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
  • Krishna Pratap Mall Department of Anaesthesia, MRA Medical College, Ambedkarnagar, Uttar Pradesh, India
  • Dipak Raval Department of Anesthesia, M. P. Shah Medical College, G. G. Hospital, Jamnagar, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20164304

Keywords:

Oral midazolam, Oral ketamine, Paracetamol rectal suppositories, Premedication

Abstract

Background: Preanaesthetic medication can play an important part in the anaesthetic care of infants and children. It plays a vital role during induction and maintenance of anaesthesia as well as in post-operative period.

Methods: Ninety pediatric patients of ASA status I and II operated for routine surgical procedures at GGH, Jamnagar, Gujarat were studied for the comparision of oral midazolam and oral ketamine as a premedication. The paediatric patients were divided into 3 groups, group M oral midazolam, group K oral ketamine and group P placebo (honey) of 30 patients each.

Results: All the patients were given general anaesthesia with injection sodium thiopentone 4 to 5 mg/kg and inj. succinylcholine 1.5 mg/kg and maintained with inj. vecuronium and traces of halothane. Paracetamol rectal suppository 10 to 15 mg/kg was inserted before reversal for post-operative analgesia. All patients were reversed with inj. neostigmine 50 μg/kg and inj. glycopyrrolate 8 μg/kg given intravenously slowly. Intraoperative pulse rate, blood pressure, SPO2 and ECG were recorded. Post operatively apart from vitals sedation score and anxiety score were recorded. The result analysed showed that sedation and anxiolysis was better in ketamine group both during separation from parents and I.V. cannulation. Recovery was smooth in ketamine group whereas recovery in midazolam group was associated with irritability and crying.

Conclusions: Oral ketamine is better premedication than oral midazolam in paediatric patients.    

References

Aasim SA, Zubair SI. Comparative study of oral ketamine and oral midazolam as premedication in paediatric patients. J Chalmeda Anand Rao Institute Med Sci. 2012;5(1):20-2.

Sington H. Discussion on medication in Anaesthesia. Proc Roy Soc Med. 1929;22:653.

Trivedi V. A comparative clinical study of tramadol versus pentazocine for sedation and analgesia as premedication a study of 60 cases. Inter J Anesthesiol. 2009;26(1):1-8.

Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. Am J Dis Child. 1953;86:587-91.

Raman TSR, Deshmukh J. Pain less invasive procedure. Indian Paedia. 1999;36:1023-8.

Eckenhoff JE. Preanaesthetic sedation of children analysis of the effects for tonsillectomy and adenoidectomy. Arch Otolaryngol. 1953;57:411.

Beeby DG. Behavior of unsedated children in anaesthetic room. British J Anaesthesia. 1980;52:279.

Steward DJ. Psychological preparation and premedication, In: Gregory GA., editor. Pediatric anesthesia. New York: Churchill Livingstone, 1983.

Korsch BM. The child and the operating room. Anaesthesiology. 1975;43:1251-7.

Reitan JA, Soliman IE. A comparison of midazolam and diazepam for induction of anaesthesia in high risk patients. Anaesth Intensive Care. 1987:15(2):175-8.

Feld LH, Negus JB, White PF. Oral midazolam pre anaesthetic medication in paediatric out patients. Anaesthesia. 1990;73:831-4.

White PF, Vasconez LO, Mathes SA. Comparison of midazolam and diazepam for sedation during plastic surgery. Plast Reconstr Surg. 1988;81(5):703-12.

Karl HW, Rosenberger JL, Larach MG. Transmucosal administration of midazolam for premedication of pediatric patients. Anaesthesiology. 1993;78:885-9.

Debnath S, Pande Y. A comparative study of oral premedication in children with ketamine and midazolam. Indian J Anaesthesia. 2003;47:45-7.

Loepke AW, Soriano SG. An Assessment of the effects of general anesthetics on developing brain structure and neurocognitive function: anesthesia and the developing brain. Anesthesia Analgesia. 2008;106(6):1681-707.

Funk W, Jakob W, Riedl T, Toeger K. Oral preanaesthetic medication for children: double blind randomized study of a combination of mizazolam and ketamine vs midazolam or ketamine alone. British J Anaesthesia. 2000;84:335-40.

Kulkarni JA. Oral Ketamine for premedication in children. Paediatric Anaesthesia. 2003;45:315-7.

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Published

2017-01-23

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Original Research Articles