A comparative study of efficacy and safety of oral ketamine and oral midazolam as premedicant for paediatric cardiac catheterization

Abstract

Use of an effective sedative premedicant significantly minimizes the emotional trauma associated with perioperative anxiety and its sequelae. Currently, oral midazolam is the most commonly used premedicant in most of the countries followed by oral ketamine. Aims and Objectives: To compare the efficacy and safety of oral ketamine and oral midazolam as premedicant for paediatric cardiac catheterization. Materials and Methods: This study was carried out in the tertiary care centre in sixty patients randomly assigned into two groups of thirty patients each, to compare the efficacy of oral ketamine and oral midazolam pre medication as sedative for paediatric patients undergoing cardiac catheterization using various parametes and observation scale of response and Visual Analogue scale. Data collected was analysed and the statistical significance of these intra-group and inter-group observations thus made was determined using either a 'Chi Square test' or an 'Unpaired T-test' or Mann whitney test. Results:The demographic trends in all the groups were comparable. The type of procedure performed were also comparable in both the groups. The mean heart rate, mean systolic and diastolic blood pressures, mean arterial blood pressure were higher in the ketamine group than in the midazolam group. Though there was fall in oxygen saturation in both the groups the ketamine group required oxygen supplementation more than midazolam group though it was statistically insignificant. The mean onset of sedation was earlier for midazolam than for ketamine. Also the parental separation was smoother and calmer in patients who had oral midazolam than oral ketamine. Similarly while positioning the children for cath study also patients medicated with midazolam showed better response than those medicated with ketamine. The response to local anaesthetic injection during femoral vessels cannulation also showed midazolam with better results. The adverse effects such as secretions, nystagmus, nausea, vomiting, delirium were more common with ketamine. The mean time spent in recovery was 53.33 minutes with ketamine group and also parental satisfaction in terms of VAS score is better and favours midazolam than ketamine. Conclusions: Oral midazolam is a better premedication of choice than ketamine for paediatric patients undergoing cardiac catheterization.