title: Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children.
abstract: BACKGROUND
  This study was done to compare effects of intranasal midazolam and intranasal midazolam with ketamine for premedication of children aged 1-12 yrs undergoing intermediate and major surgeries.
  
  
  OBJECTIVE
  Midazolam and Ketamine have already been used as premedicants in children. Our aim was to find out advantage of combination of midazolam with ketamine over midazolam by nasal route.
  
  
  METHODS
  Sixty children of age group 1-12 yrs of American Society of Anesthesiologists (ASA) grade 1 and 2 were selected. Group A- midazolam (0.2 mg/kg), Group B- midazolam (0.15 mg/kg + ketamine 1 mg/kg). Both groups received drug intranasally 30 min before surgery in recovery room with monitored anesthesia care. Onset of sedation, sedation score, emotional reaction, intravenous cannula acceptance, and mask acceptance were studied.
  
  
  METHODS
  Unpaired t test and chi square test.
  
  
  RESULTS
  Sedation score, anxiolysis, attitude, reaction to intravenous cannulation, face mask acceptance, and emotional reaction were significantly better in midazolam with ketamine group. Intra operatively, in both groups, pulse rate, oxygen saturation, and respiratory rate had no significant difference; also, post operatively, no significant difference was observed in above parameters, post operative analgesia was significantly better in midazolam with ketamine group.
  
  
  CONCLUSIONS
  Intra nasal premedication allows rapid and predictable sedation in children. Midazolam as well as combination of Midazolam with ketamine gives good level of sedation and comfort. But quality of sedation, analgesia, and comfort is significantly better in midazolam with ketamine group. No significant side effects were observed in both groups.
authors.affiliation: Department of Anesthesiology, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai, Maharashtra, India.
authors.forename: Sonal S
authors.initials: SS
authors.lastname: Khatavkar
authors.affiliation: Department of Anesthesiology, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai, Maharashtra, India.
authors.forename: Rochana G
authors.initials: RG
authors.lastname: Bakhshi
keywords: Intranasal; Ketamine; midazolam; pediatric anesthesia