title: Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children.
abstract: To determine which of three types of rectal sedation was most effective preoperatively in facilitating parental separation and intravenous cannulation in young children, 100 children 3.0 +/- 1.7 (mean +/- SD) yr of age were randomly assigned to four equal groups. One group (M-K-A) received rectal midazolam (0.5 mg/kg), ketamine (3 mg/kg), and atropine (0.02 mg/kg). The other sedation groups received the same doses of midazolam and atropine (M-A) or ketamine and atropine (K-A) alone, and the control group (A) received only rectal atropine. Most children in either the M-K-A (100%) or M-A (92%) groups separated easily from their parents without struggling or crying, significantly more than in the K-A (60%) or A (64%) groups. However, more children in the M-K-A group (44%) were asleep during separation than in the M-A group (8%; P < 0.05). Only 20% of the children in the M-A or M-K-A groups cried during intravenous catheter placement, significantly less than in the K-A (56%) or A (92%) groups. Intravenous catheter placement was also successful significantly more often in the M-A (80%) and M-K-A (84%) groups than in the K-A (48%) or A (40%) groups. Complications were similar among the groups, but there was evidence that midazolam prolonged recovery time in some patients. Rectal midazolam with or without ketamine is a useful technique when intravenous catheter placement before induction of anesthesia is desired.
authors.affiliation: Department of Anesthesiology, University of Minnesota Hospitals and Clinics, Minneapolis 55455.
authors.forename: D S
authors.initials: DS
authors.lastname: Beebe
authors.forename: K G
authors.initials: KG
authors.lastname: Belani
authors.forename: P N
authors.initials: PN
authors.lastname: Chang
authors.forename: P S
authors.initials: PS
authors.lastname: Hesse
authors.forename: J S
authors.initials: JS
authors.lastname: Schuh
authors.forename: J C
authors.initials: JC
authors.lastname: Liao
authors.forename: R J
authors.initials: RJ
authors.lastname: Palahniuk
mesh_terms: D000285:Administration, Rectal; D001010:Anxiety, Separation / Q000517:prevention & control; D001285:Atropine / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D011229:Preanesthetic Medication
chemical_list: D004338:Drug Combinations; D007649:Ketamine; D001285:Atropine; D008874:Midazolam