Related Experiment Videos
Ketamine plus midazolam, a most effective paediatric oral premedicant
D L Warner1, J Cabaret, D Velling
1University of Southern California-Los Angeles County Medical Center, Department of Anesthesiology 90033, USA.
Insights
A combination of ketamine and midazolam provides the most effective oral sedation for pediatric patients undergoing surgery. This mixture demonstrated superior success rates for both parental separation and mask induction in children aged 1.5 to seven years.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Surgical Sedation
Background:
- Effective and safe sedation is crucial for pediatric surgical procedures.
- Oral administration of sedatives offers a less invasive pre-anesthetic approach.
- Evaluating combined sedative agents can optimize pediatric pre-operative care.
Purpose of the Study:
- To compare the efficacy of oral midazolam, ketamine, and a combination of ketamine and midazolam for pre-anesthetic sedation in children.
- To assess the success rates of sedation for parental separation and mask induction.
Main Methods:
- A randomized study involving 60 healthy children aged 1.5 to seven years, divided into three groups.
- Group 1 received midazolam (0.5 mg/kg), Group 2 received ketamine (6 mg/kg), and Group 3 received a mixture of midazolam (0.4 mg/kg) and ketamine (4 mg/kg).
- All oral doses included atropine and were administered 20-30 minutes prior to surgery, with sedation success graded during parental separation and mask induction.
Main Results:
- The ketamine+midazolam mixture achieved 100% success for parental separation, compared to 90% for ketamine alone and 75% for midazolam alone.
- For mask induction, the ketamine+midazolam mixture showed an 85% success rate, versus 65% for midazolam and 42% for ketamine.
- A sedation grade of 1-3 (asleep, easily aroused, or awake/calm) was considered successful.
Conclusions:
- The combination of oral ketamine and midazolam is the most effective pre-anesthetic sedation strategy for pediatric patients.
- This synergistic combination significantly improves patient comfort and cooperation during the pre-operative period.
- Further research into optimal dosing and combinations for pediatric sedation is warranted.
Abstract:
Healthy children, 1.5 to seven years old, were divided into three groups of 20 each. Group 1 received midazolam 0.5 mg.kg-1, Group 2, ketamine 6 mg.kg-1 and Group 3 a mixture of midazolam 0.4 mg.kg-1 + ketamine 4 mg.kg-1. Each dose was mixed with atropine 0.02 mg.kg-1 plus an equal volume of cherry syrup and was given orally 20 to 30 min prior to surgery. A grade of 1 (asleep, difficult to arouse), 2 (asleep, easily aroused), 3 (awake, calm), 4 (awake, anxious, occasional cry), or 5 (crying, agitated), was assigned at the time of parental separation and again when mask induction was begun. A grade of 1-3 was considered successful. For parental separation, the mixture of ketamine+midazolam was 100% successful, ketamine 90% and midazolam 75%. Successful mask induction for the mixture of ketamine+midazolam was 85%, midazolam 65% and ketamine 42%. This study indicates that a mixture of ketamine+midazolam is the most effective.