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Efficacy of intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial

Hossein Khoshrang1, Cyrus Emir Alavi1, Siamak Rimaz1

  • 1Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences , Rasht, Iran.

Caspian Journal of Internal Medicine
|November 25, 2021
PubMed

Insights

Intranasal ketamine and midazolam effectively sedate pediatric patients before surgery. While both are safe, ketamine prolonged recovery time in children undergoing urologic procedures.

Area of Science:

  • Anesthesiology and Pain Management
  • Pediatric Surgery
  • Pharmacology

Background:

  • Pediatric patients experience significant fear and anxiety during surgical procedures.
  • Optimal drug and administration route for pediatric premedication remain undetermined.
  • Intranasal (IN) administration offers a needle-free alternative for pediatric medication delivery.

Purpose of the Study:

  • To compare the efficacy and safety of intranasal ketamine versus midazolam for premedication in pediatric patients.
  • To evaluate sedation and separation anxiety scores in children receiving IN ketamine or midazolam.
  • To assess hemodynamic stability and postoperative side effects associated with IN premedication.

Main Methods:

  • A study involving 71 eligible pediatric patients aged 2 to 6 years undergoing elective urologic surgeries.
  • Comparison of sedation and separation anxiety scores between intranasal ketamine (Group K) and intranasal midazolam (Group M) groups.
  • Documentation and comparison of hemodynamic parameters and postoperative adverse events.

Main Results:

  • No significant difference in sedation scores (P=0.17) or separation anxiety scores (P=0.01) between ketamine and midazolam groups.
  • Significantly longer recovery time in the ketamine group (38.19±6.67 min) compared to the midazolam group (27.86±4.42 min) (P=0.01).
  • Hemodynamic parameters remained within physiological limits in both groups, with no significant fluctuations.

Conclusions:

  • Both intranasal ketamine and midazolam are effective and safe premedication options for inducing sedation in young children.
  • Intranasal midazolam may offer a faster recovery profile compared to intranasal ketamine in pediatric surgical patients.
  • Further research may explore optimal dosing and specific indications for each agent in pediatric premedication.
Abstract

Keywords:
IntranasalKetamineMidazolamPediatricsSedation

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