Oral premedication in children: A randomized study of a combination of oral midazolam, ketamine with atropine vs midazolam and atropine vs ketamine and atropine

Introduction: Premedication is widely used in pediatric anesthesia in order to provide sedation and anxiolysis. Aim of the study was to compare the effectiveness of combination of low dose oral midazolam and ketamine with oral midazolam or oral ketamine as premedication. Materials and Methods: 150 childrens between ages 2 and 10 were divided into 3 groups of 50 members each. They received either combination of oral midazolam 0.5 mg/kg and oral ketamine 3mg/kg or oral midazolam 0.5 mg/kg or oral ketamine 6 mg /kg as pre medication. Premedication was given 30 minutes before the induction of anesthesia. Patients also received oral atropine 0.02mg/kg along with the study drug. Sedation and anxiolysis were assessed before giving premedication and at an interval of 10 minutes, 20 minutes and 30 minutes after premedication. Behavior at separation from parents and acceptance or response to venipuncture was also assessed at the end of 30 minutes. Statistical analysis was performed using SSPE computer software version 16. Groups are compared using chi square tests. Result: We found that oral combination of midazolam 0.5 mg/kg and ketamine 3 mg/kg with atropine 0.02mg/kg offered better sedation [96% children], anxiolysis [76% children], acceptance of parentral separation [80% children] and comfortable venous cannulation [84% children]. We conclude that Combination of oral ketamine, midazolam and atropine is a superior premedicating agent than using these drugs individually.