The comparison of the efficacy and safety of midazolam, ketamine, and midazolam combined with ketamine administered nasally for premedication in children

Abstract

Background:In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children.Material and Methods:We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0.1 mg/kg Midazolam + 3 mg/kg ketamine in Group MK. Patients were evaluated for sedation, anxiety scores, respiratory, and hemodynamic effects before premedication, 5 min interval between induction and postoperative period.Results:There was no difference with respect to age, sex, weight, the duration of the operation, and for mask tolerance. Sedation scores were significantly higher in Group MK. There was no statistically difference between the groups for heart rate, oxygen saturation, and respiratory rate.Conclusion:We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.

Comparison of intranasal dexmedetomidine-midazolam, dexmedetomidine-ketamine, and midazolam-ketamine for premedication in paediatric patients: a double-blinded randomized trial

“…Excessive salivation associated with ketamine was absent at the dose 2 mg kg -1 intranasally in our study, similarly to the study of Bhat et al [7,15]. The study conducted by Akcay et al [14] showed no emergence delirium or other complications, highlighting the safety of na sal ketamine with midazolam as a premedicant in paediatric patients. However, we did not follow the patients in the postoperative period.…”

“…In our study, an intranasal dose of 0.12 mg kg -1 midazolam, 1 μg kg -1 dexmedetomidine, and 2 mg kg -1 ketamine in combination for premedication was chosen, similarly to previous studies [7,14]. These doses produced good sedation and parental sepa ration with stable haemodynamics.…”

“…The combination of several sedative drugs was found to have a better effect in most of the studies conducted using them [6,[14][15][16][17], while the intra nasal route is relatively safe, noninvasive, and by FIGURE 2. Ease of intravenous cannulation at 30 minutes.…”

Post-Discharge Effects and Parents’ Opinions of Intranasal Fentanyl with Oral Midazolam Sedation in Pediatric Dental Patients: A Cross-Sectional Study

“…Midazolam is a common sedative drug delivered to pediatric patients orally to reduce anxiety in the dental clinic [ 6 , 9 , 10 ]. Midazolam is a benzodiazepine derivative that has sedative, anxiolysis, and anterograde amnesia properties with a wide margin of safety [ 11 , 12 , 13 ].…”