Nasal low dose ketamine combined with midazolam for paediatric premedication

ABSTRACT

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