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Preoperative sedation with intravenous S-ketamine versus midazolam in preschool children: a randomized controlled

Yu-Qi Liao1, Jun Ma2, Yi He2

  • 1Department of Anesthesiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, 610031, China.

BMC Anesthesiology
|November 22, 2025
PubMed

Insights

S-ketamine (0.5 mg/kg) provided deeper sedation than midazolam (0.08 mg/kg) for preschool children undergoing anesthesia. While effective for preoperative anxiety, S-ketamine slightly increased emergence time.

Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Pharmacology

Background:

  • Preoperative anxiety in children can lead to difficult parent-child separation and anesthesia induction challenges.
  • Effective preoperative sedation is crucial for managing anxiety in preschool-aged children.
  • This study addresses the need for optimal sedation strategies in pediatric anesthesia.

Purpose of the Study:

  • To compare the efficacy of S-ketamine versus midazolam for preoperative sedation in children aged 2-6 years.
  • To evaluate sedative effects, parent separation anxiety, postoperative agitation, satisfaction, and mask compliance.

Main Methods:

  • A prospective randomized controlled trial involving 104 children aged 2-6 years.
  • Children were assigned to receive either S-ketamine (0.5 mg/kg) or midazolam (0.08 mg/kg) intravenously.
  • The Modified Yale Preoperative Anxiety Scale (mYPAS) was the primary outcome measure.

Main Results:

  • Both S-ketamine and midazolam effectively controlled preoperative stress.
  • S-ketamine resulted in significantly lower mYPAS scores compared to midazolam (P=0.025).
  • A longer emergence time was observed with S-ketamine (P=0.036), with no significant differences in other secondary outcomes.

Conclusions:

  • A single intravenous dose of S-ketamine (0.5 mg/kg) offers superior sedative effects compared to midazolam (0.08 mg/kg) in pediatric patients.
  • S-ketamine is an effective option for managing preoperative anxiety in children, despite a potential for slightly prolonged emergence.
  • The findings support S-ketamine as a valuable alternative for preoperative sedation in pediatric anesthesia.
Abstract

Keywords:
ChildrenMidazolamPremedicationS-ketamine

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