A study of injection Midazolam, ketamine and combination of both as premeditation in pediatric surgeries: A tertiary care teaching hospital study.

Abstract

Background: The pediatric surgeons deal with the congenital anomalies, trauma, tumors, major surgical infections, antenatal diagnosis and counseling related to various sub specialties such as Pediatric neurosurgery, thoracic, urology, plastic, gastrointestinal, traumatology, oncology, and neonatal surgery including many others belonging to man's land from newborn stage to 14 or sometimes even 18 years of age. In 1960s, there was an enormous challenge to operate upon children.

Aims and Objectives: To Assess and  compare the Midazolam, ketamine and combination of both as premeditation in pediatric surgeries in our tertiary care hospital. 

Materials And Methods: A total of 52 children were enrolled. Only children less than 12 years and more than 2 years of age were included. Complete demographic and clinical details of all the subjects was recorded. Inclusion criteria for the present study included children undergoing orthopedic, pediatric, ophthalmic or plastic surgery lasting for 40 minutes to 150 minutes. Thorough pre-treatment examination of all the patients was carried out. Random division of all the patients was done into two study groups as follows:Group 1: 25 pediatric patients subjected to Intranasal Midazolam (0.2 mg/kg), and Group 2: 25 pediatric patients subjected to Intranasal Midazolam (0.15 mg/kg) with Ketamine [1 mg/kg].

Results and Observations: Among group 1, there were 14 boys and 12 girls while among group 2, there were 16 boys and 10 girls. Significant results were obtained while comparing the level of sedation at 20 minutes. While comparing the emotional reaction at 20 minutes in between the two study groups, significant results were obtained. Mean onset time of sedation among patients of group 1 and group 2 was 10.95 minutes and 10.08 minutes respectively. Mean postoperative recovery time was 22.12 minutes and 29.23 minutes respectively. Postoperative analgesic requirement was seen in 64 percent of the patients of group 1 while it was seen in 16 percent of the patients of group 2.

Conclusion: Children can be sedated quickly and predictably with intranasal premedication. The midazolam plus ketamine group considerably provides superior analgesia, sedation, and comfort.