Comparative study between oral midazolam and oral ketamine as preanaesthetic medication in paediatric patients undergoing elective surgery: a randomized double blind study

Introduction: Prime objective of anaesthesiologist is to minimize adverse psychological and physiological effects of anaesthetic technique. Premedication causes sedation and reduction of anxiety during separation from parents. It also provides a calm and cooperative child for smooth induction of anesthesia. We evaluated the differences in quality of premedication with orally administered midazolam and ketamine in the paediatric population undergoing elective surgical procedures and tried to ascertain the minimum interval required between premedication and parental separation. Objective: This study was undertaken to compare the efficacy and safety of oral midazolam and oral ketamine as a preanaesthetic medication for paediatric patients undergoing elective surgery. Materials and Methods: In this prospective, randomized, double blind study a total of 60 children aged 1-6 years, belonging to ASA grade 1 and 2, scheduled for elective surgery were randomized into two groups of 30 each to receive either midazolam 0.5 mg/kg (Group A) or ketamine 5 mg/kg (Group B) orally. Parameters to be assessed were quality of sedation and anxiolysis, ease of parent-child separation and ease of venepuncture. Results: Overall success rate of midazolam for sedation and anxiolysis was higher than ketamine in all the time frames. Successful separation from parents was easy in 25 patients (83.33%) in group A and 13 patients (43.33%) in group B. Successful venepuncture was obtained in 93.33% and 90% of patients in group A and group B respectively. This higher rate of success during venepuncture was probably due to use of EMLA cream prior to venepuncture. Conclusion: We concluded that premedication with oral midazolam 0.5mg/kg provides better sedation and anxiolysis, easy parent child separation than oral ketamine 5mg/kg.