title: Efficacy of two oral premedicants: midazolam or a low-dose combination of midazolam-ketamine for reducing stress during intravenous cannulation in children undergoing CT imaging.
abstract: BACKGROUND
  Pain, anxiety and fear of needles make intravenous cannulation extremely difficult in children. We assessed the efficacy and safety of oral midazolam and a low-dose combination of midazolam and ketamine to reduce the stress and anxiety during intravenous cannulation in children undergoing computed tomography (CT) imaging when compared to placebo.
  
  
  METHODS
  Ninety-two ASA I or II children (1-5 years) scheduled for CT imaging under sedation were studied. Children were randomized to one of the three groups. Group M received 0.5 mg x kg(-1) midazolam in 5 ml of honey, group MK received 0.25 mg x kg(-1) midazolam mixed with 1 mg x kg(-1) ketamine in 5-ml honey and group P received 5-ml honey alone, orally. In 20-30 min after premedication, venipuncture was attempted at the site of eutectic mixture of local anesthetics cream. Sedation scores and venipuncture scores were recorded. Primary outcome of the study was incidence of children crying at venipuncture (venipuncture score of 4).
  
  
  RESULTS
  Significantly more children cried during venipuncture in placebo group compared to the other two groups (19/32 (59%) in group P vs 1 each in groups M and MK, (P < 0.001) (RR 2.37, 95% CI 1.55-3.63). In 20-30 min after premedication, group P had more children in sedation score 1 or 2 (crying or anxious) compared to the other two groups (P < 0.05). At this time, group MK showed more children in calm and awake compared to group M (P = 0.02). At venipuncture, group P had more children in venipuncture score 3 or 4 (crying or withdrawing) compared to group M or MK (P < 0.05), while groups M and MK were comparable.
  
  
  CONCLUSIONS
  A low-dose combination of oral midazolam and ketamine or oral midazolam alone effectively reduces the stress during intravenous cannulation in children undergoing CT imaging without any adverse effects. However, the combination provides more children in calm and quiet state when compared to midazolam alone at venipuncture.
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kajal
authors.initials: K
authors.lastname: Jain
authors.forename: Babita
authors.initials: B
authors.lastname: Ghai
authors.forename: Akshay K
authors.initials: AK
authors.lastname: Saxena
authors.forename: Deepak
authors.initials: D
authors.lastname: Saini
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
mesh_terms: D000284:Administration, Oral; D000778:Anesthetics, Dissociative / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy / Q000523:psychology; D002406:Catheterization, Peripheral / Q000523:psychology*; D002675:Child, Preschool; D003448:Crying / Q000523:psychology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000379:methods / Q000523:psychology; D005260:Female; D006722:Honey; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D011292:Premedication / Q000379:methods* / Q000523:psychology; D013315:Stress, Psychological / Q000188:drug therapy* / Q000523:psychology; D014057:Tomography, X-Ray Computed / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D000778:Anesthetics, Dissociative; D014151:Anti-Anxiety Agents; D007649:Ketamine; D008874:Midazolam