Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children

Abstract

Purpose: To evaluate the efficacy and safety of intranasally administered s-ketamine and midazolam for premedication in pediatric patients, Methods: Ninety children were randomly allocated to receive intranasally administered s-ketamine 1 mg·kg-1 and midazolam 0.2 mg·kg-1 (Group K1, n = 30), s-ketamine 2 mg·kg-1 and midazolam 0.2 mg·kg-1 (Group K2, n = 30), or midazolam 0.2 mg·kg-1 (Group M, n = 30) as premedicants, using a double-blind study design. Sedation and anxiolysis were evaluated using a sedation and cooperation scale and recorded at several time points. Results: Acceptable conditions (K1: 23; K2: 26, M: 19) for parental separation were not different between groups. Induction conditions were acceptable in 26 patients in K2 (P < 0.05 vs M) (K1: 23; M: 19). Compared to baseline values individual conditions significantly improved in groups K1 and K2 from 2.5 min after premedication until induction of anesthesia (P < 0.003), in group M conditions improved only five minutes after premedication (P < 0.05). Adverse effects observed in this series were within an acceptable range and similar for the three groups. Conclusion: Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children.