Related Experiment Video

Updated: Aug 13, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 18, 2011

Two doses of oral ketamine, given with midazolam, for premedication in children

M Astuto1, N Disma, E Crimi

  • 1Department of Anesthesia and Resuscitation, University of Catania, Catania, Italy. astmar@tiscalinet.it

Minerva Anestesiologica
|September 24, 2002
PubMed

Insights

Oral ketamine and midazolam effectively improve pediatric premedication. Higher doses of ketamine (2 mg/kg) with midazolam enhanced sedation, anxiolysis, and mask acceptance during anesthesia induction.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Oral premedication is a standard procedure in pediatric anesthesia.
  • Assessing the efficacy of oral ketamine combined with midazolam for premedication is crucial.

Purpose of the Study:

  • To evaluate the quality of oral premedication using ketamine and midazolam in pediatric patients.
  • To compare the anxiolytic and sedative effects of different oral ketamine doses combined with midazolam.

Main Methods:

  • A randomized, blind clinical study involving 120 pediatric patients (2-6 years) undergoing minor surgery.
  • Patients were divided into three groups: two receiving different doses of oral ketamine with midazolam, and one control group receiving midazolam.
  • Premedication success was assessed by scoring anxiolysis and sedation at intervals and during key procedural moments.

Main Results:

  • The group receiving 2 mg/kg ketamine with midazolam (MK2) showed significantly higher successful premedication rates after 20 minutes (p<0.05).
  • Patients in the MK2 group exhibited greater acceptance of parental separation (p<0.05) and the anesthesia face mask (p<0.05).
  • Minor, spontaneously resolving side effects (nausea, headache, diplopia) were noted in 4 patients in the MK2 group.

Conclusions:

  • Oral administration of 2 mg/kg ketamine with midazolam significantly enhances anxiolysis and sedation in pediatric patients.
  • This combination improves overall premedication success, leading to better acceptance of parental separation and anesthesia mask induction.
  • The findings support the use of higher-dose oral ketamine with midazolam for improved pediatric premedication outcomes.
Abstract

More Related Videos

In vivo Calcium Imaging in Mouse Inferior Olive08:58

In vivo Calcium Imaging in Mouse Inferior Olive

Published on: June 10, 2021

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery09:47

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Published on: June 2, 2022

Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
Drugs in...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...