Intranasal midazolam Vs ketamine as premedication in paediatric surgical procedure for child separation and induction

Area of Science:

• Anesthesiology
• Pediatric Medicine
• Pharmacology

Background:

• Pre-anesthetic medications are crucial for managing pediatric surgical anxiety and facilitating smooth induction.
• Traditional administration routes (oral, rectal, IV, IM) have drawbacks, including painful injections.
• Intranasal drug delivery offers a needle-free, convenient alternative for pre-anesthetic medication in children.

Purpose of the Study:

• To evaluate the efficacy of intranasal Midazolam (0.2 mg/kg) and Ketamine (5 mg/kg) for pre-anesthetic medication in pediatric patients.
• To compare the effectiveness of these two intranasal agents in reducing pre-operative stress and anxiety.

Main Methods:

• A study involving 50 pediatric patients (ASA I-II, age 1-7 years) undergoing elective surgery.
• Patients were divided into two groups: Group I received intranasal Midazolam, and Group II received intranasal Ketamine.
• Key outcome measures included time of separation from parents and ease of intravenous (IV) line insertion.

Main Results:

• A statistically significant difference was observed in the mean time of separation from parents between the two groups (p < 0.001).
• Intranasal Midazolam showed a significant reduction in separation anxiety compared to Ketamine.
• No significant difference was found in the ease of IV line insertion between the intranasal Midazolam and Ketamine groups.

Conclusions:

• Intranasal Midazolam and Ketamine are effective pre-anesthetic medications for pediatric patients.
• Intranasal Midazolam significantly improved the time of separation from parents, highlighting its benefit in reducing pre-operative anxiety.
• Intranasal administration provides a viable, needle-free route for pediatric pre-medication, improving patient and potentially parental comfort.