Nasal low dose ketamine combined with midazolam for paediatric premedication

Sixty Children aged from three to six years scheduled for tonsillectomy or bilateral insertion of tympanotomy tubes under general anaesthesia were studied. The patients were randomly allocated into two groups where group [A] received a combination of intranasal ketamine [2 mg/kg] and midazolam [0.1 mg/kg] and group [B] received placebo [normal saline]. Anaesthesia was induced with 5% halothane and 100% 02 via face mask, subjects given intranasal combination of ketamine-midazolam were more likely to separate willingly from their parents at or before 10 minutes compared to patients given placebo. 60% of patients given this combination separated at 4 minutes compared to 20% of patients given placebo. The quality of subsequent halothane induction was excellent in 70% of patients given this combination and adequate in the remaining 30%. In 70% of patients given placebo induction was unacceptable. There were no incidents of any behavioral changes or psychological disturbances in patients given this intranasal combination. No statistically significant difference as regards recovery time was recorded between both groups. It can he concluded that nasal low dose ketamine combined with midazolam provides an effective paediatric premedication with regard to sedation and mask acceptance. It has rapid action with no prolongation of recovery time and no instances of emergence phenomena. Nasal ketamine- midazolam combination offers an alternative to intramuscular or per rectum routes for preanaesthetic sedation in young children aged from three to six years

Epidural fentanyl and 0.5 bupivacaine for elective cesarean section. Effects on shivering, maternal and neonatal outcome / bupivacaine for elective caesarean section. Effects on shivering, maternal and neonatal outcome.

The aims of this study were to investigate whether 100 microgram fentanyl administered prophylactically by the epidural route would influence the incidence of shivering in parturients who underwent elective caesarean section under epidural analgesia and whether it would affect the maternal and neonatal outcome. Forty mothers of ASA physical status I or II presenting for elective Caesarean section were divided into two equal groups according to type of solution injected in the epidural space. Patients of Group A received 100 microgram fentanyl in addition to 0.5 percent bupivacaine while patients of group B received 0.5 percent bupivacaine alone. Shivering occurred in 20 percent of patients of group A and in 70 percent of patients of group B. There was 72 percent reduction in the incidence of shivering in mothers receiving epidural 100 microgram fentanyl with no further adverse actions on maternal and neonatal outcome. None of the neonates required resuscitation and there was no immediate or delayed respiratory depression in mothers. Only two mothers who received fentanyl required analgesic supplementation during surgery compared with ten mothers who did not receive epidural fentanyl. Another finding in our study was the markedly prolonged post-operative analgesia in patients of group A compared with group B. So, it can be concluded that the addition of 100 microgram fentanyl in the epidural space prophylactically in elective Caesarean section reduced significantly the incidence and severity of shivering and significantly improved operative comfort and duration of post-operative analgesia with no deleterious effects on neonatal and maternal outcome