Efficacy of oral ketamine and oral midazolam as premedicants in the paediatric population undergoing elective surgical procedures

Abstract

Background and Aim: Oral ketamine produces predictable satisfactory sedation and anxiolysis without significant side effects like respiratory depression or emergence delirium in children. this study is being carried out to compare Oral ketamine with oral midazolam to know the efficacy of both the drugs as premedicants in the paediatric population undergoing elective surgical procedures and ascertain the minimum interval required between premedication and parental separation. Material and Methods: Present prospective, randomized study was conducted in 80 children in the age group of 4-12 years, of either sex or the American Society of Anesthesiologists (ASA) Physical status 1, posted for elective surgery. Patients were randomized by simple sealed envelope method into two groups of 40 each: Group A: received 0.5mg/kg midazolam and group B: received 5mg/kg ketamine orally. Before and after premedication sedation and anxiolysis score were assessed, after premedication it was assessed at 10, 20, and 30 minutes. Thirty five minutes after oral premedication, children were separated from parents. During parental separation, parent child separation score was assessed and recorded. Results: At 10 minutes of premedication, 28 (70%) and 35(87.5%) patients had unsuccessful and 12(30%) and 5(12.5%) had successful sedation scores in midazolam and ketamine group respectively. At 20 minutes of premedication, 9(22.5%) and 28(70%) patients had unsuccessful and 31(77.5%) and 12(12%) had successful sedation scores in midazolam and ketamine group respectively. While at 30 minutes of premedication, 4(10%) and 17(42.5%) patients had unsuccessful and 36(90%) and 23(58.7%) had successful sedation scores in midazolam and ketamine group respectively. These results were statistically significant (P≤ 0.05) Conclusion: Oral midazolam was superior to the ketamine for providing easy separation from parents and excellent mask acceptance in children. Oral midazolam had faster onset of sedation and provided higher sedation scores and lower anxiety scores as compared to ketamine.