Intranasal midazolam versus intranasal ketamine as premedication in paediatric patients: A comparative study

Abstract

This study aims to compare the efficacy of intranasal midazolam and ketamine as premedication before anaesthesia in paediatric patients. Materials and Methods: Sixty pediatric patients scheduled for surgery between the age group of 2-8 years and belonging to the American Society of Anesthesiologists (ASA) grade I and II were selected for the study. Group A received midazolam (0.2 mg/kg) and Group B received ketamine (5 mg/kg), intranasally 30 minutes before surgery with monitored anesthesia care. Sedation score, parenteral separation reaction, intravenous cannula acceptance, mask acceptance, and hemodynamic parameters were measured. Results: Patients of both the groups were calm and tranquil, but sedation scores were higher in the ketamine group (3.37±0.67) in comparison to midazolam group (2.60±0.67) at 30 minutes. Parenteral separation was easier in ketamine group compared to midazolam group with a significantly higher separation reaction scores (p<0.05). Venous cannulation and face mask acceptance was also better in the ketamine group with a significantly higher percentage of patients with satisfactory venous cannulation and face mask acceptance (p<0.05). Non-invasive blood pressure, oxygen saturation, and respiratory rate were maintained in both the groups throughout the study period, however tachycardia was observed in the ketamine group. Conclusion: Administration of the drug through the nasal route is an effective way for paediatric premedication. Both midazolam and ketamine gave a good level of sedation, however, level of sedation, venipuncture acceptance, and face mask acceptance were significantly better in the ketamine group. No adverse effects of the premedication drugs were observed in any of the groups.