Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children.
OBJECTIVE
To evaluate the efficacy and safety of intranasally administered s-ketamine and midazolam for premedication in pediatric patients.


METHODS
Ninety children were randomly allocated to receive intranasally administered s-ketamine 1 mg.kg(-1) and midazolam 0.2 mg.kg(-1) (Group K1, n = 30), s-ketamine 2 mg.kg(-1) and midazolam 0.2 mg.kg(-1) (Group K2, n = 30), or midazolam 0.2 mg.kg(-1) (Group M, n = 30) as premedicants, using a double-blind study design. Sedation and anxiolysis were evaluated using a sedation and cooperation scale and recorded at several time points.


RESULTS
Acceptable conditions (K1: 23; K2: 26, M: 19) for parental separation were not different between groups. Induction conditions were acceptable in 26 patients in K2 (P < 0.05 vs M) (K1: 23; M: 19). Compared to baseline values individual conditions significantly improved in groups K1 and K2 from 2.5 min after premedication until induction of anesthesia (P < 0.003), in group M conditions improved only five minutes after premedication (P < 0.05). Adverse effects observed in this series were within an acceptable range and similar for the three groups.


CONCLUSIONS
Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children.
Clinic for Anesthesiology and Critical Care Medicine, University Hospital Kiel, Kiel, Germany. frank.weber@klinik.uni-regensburg.de
Frank
F
Weber
Hinnerk
H
Wulf
Ghada
G
el Saeidi
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects; D000281:Administration, Intranasal; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000758:Anesthesia / Q000379:methods; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D011229:Preanesthetic Medication / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000700:Analgesics; D007649:Ketamine; D008874:Midazolam