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Canadian Journal of Anesthesia 50:470-475 (2003)
© Canadian Anesthesiologists' Society, 2003
Obstetrical and Pediatric Anesthesia

Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children

[La prémédication nasale avec s-kétamine et de midazolam fournit de bonnes conditions d’induction de l’anesthésie chez de jeunes enfants]

Frank Weber, MD, Hinnerk Wulf, MD and Ghada el Saeidi, MD

From the Clinic for Anesthesiology and Critical Care Medicine, University Hospital Kiel, Kiel, Germany.

Address correspondence to: Dr. Frank Weber, Department of Anesthesia, University of Regensburg, 93042 Regensburg, Germany. Phone: +49 941 944-7827; Fax: +49 941 944-7802; E-mail: frank.weber{at}klinik.uni-regensburg.de

Purpose: To evaluate the efficacy and safety of intranasally administered s-ketamine and midazolam for premedication in pediatric patients.

Methods: Ninety children were randomly allocated to receive intranasally administered s-ketamine 1 mg•kg-1 and midazolam 0.2 mg•kg-1 (Group K1, n = 30), s-ketamine 2 mg•kg-1 and midazolam 0.2 mg•kg-1 (Group K2, n = 30), or midazolam 0.2 mg•kg-1 (Group M, n = 30) as premedicants, using a double-blind study design. Sedation and anxiolysis were evaluated using a sedation and cooperation scale and recorded at several time points.

Results: Acceptable conditions (K1: 23; K2: 26, M: 19) for parental separation were not different between groups. Induction conditions were acceptable in 26 patients in K2 (P < 0.05 vs M) (K1: 23; M: 19). Compared to baseline values individual conditions significantly improved in groups K1 and K2 from 2.5 min after premedication until induction of anesthesia (P < 0.003), in group M conditions improved only five minutes after premedication (P < 0.05). Adverse effects observed in this series were within an acceptable range and similar for the three groups.

Conclusion: Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children.




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