[Comparison of preanesthetic sedation after intranasal administration of fentanyle, ketamin and midazolam]

ABSTRACT

Induction of anesthesia in children can be a challenge for anesthetist. A stormy induction may increase the personality and behavioral changes. Therefore, it is desirable that they enter the operating room sedated. Many drugs are used for preanesthetic medication and there are many routes for administration. One route of administration is nasal mucous. In this study we compared the effect and side effect of three drugs [midazolam, ketamin and fentanyle] after intra nasal administration. This is a double blind clinical trial. In this study we selected 60 patients [20 patients for every group A, B or C.] We used 3 mg/kg ketamin or 3 microg/kg fentanyle or 0.3 mg/kg midazolam by intranasal spray. After administration and in 5, 10 and 15 minutes, we observed the SPO2, PR and RA. After 15 min's we separated children from parents and brought them to the operating room and controlled the acceptance of separation, depth of sedation with Ramsay score, acceptance of mask and tolerance of IV canulation. The data were then analyzed using K2 and kruskal-wallis test. In our study we found that in SPO2 fentanyle had the highest rate of reduction even though none of the children had SPO2 lower than 90%.There were no differences between drugs in RA. In fentanyle group, we had the lowest rate and in ketamin group the highest rate. Midazolamhad the medium rate. The rate of sedation for acceptance of separation from parents had no difference between the groups and all drugs with this dosage were effective for this aim. However, in Ramsay score, acceptance of mask and tolerance of IV canulation, the midazolam was more effective than the others. Intranasal administration of midazolam is a safe route for sedation in children in the pre-anesthetic time