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Comparison of the effects of intravenous premedication: Midazolam, Ketamine, and combination of both on reducing anxiety in pediatric patients before general anesthesia.

Sajedi P, Habibi B - J Res Pharm Pract (2015 Oct-Dec)

Bottom Line: We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia.After premedication, children's behavior was significantly better in the combination group (P < 0.001).Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more desirable behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Objective: In some medical circumstances, pediatric patients may need premedication for transferring to the operating room. In these situations, using intravenous premedication is preferred. We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia.

Methods: In a double-blind randomized clinical trial, 90 pediatric patients aged 6 months to 6 years with American Society of Anesthesiologist grade I or II were enrolled. Before anesthesia, children were randomly divided into three groups to receive intravenous midazolam 0.1 mg/kg, or intravenous ketamine 1 mg/kg, or combination of half doses of both. Behavior types and sedation scores were recorded before premedication, after premedication, before anesthesia, and after anesthesia in the postanesthesia care unit. Anesthesia time, recovery duration, blood pressure, and heart rate were also recorded. For comparing distribution of behavior types and sedation scores among three groups, we used Kruskal-Wallis test, and for comparing mean and standard deviation of blood pressure and heart rates, we used analysis of variance.

Findings: After premedication, children's behavior was significantly better in the combination group (P < 0.001). After anesthesia, behavior type was same among three groups (P = 0.421). Sedation scores among three groups were also different after premedication and the combination group was significantly more sedated than the other two groups (P < 0.001).

Conclusion: Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more desirable behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg.

No MeSH data available.


Related in: MedlinePlus

Comparison of the means of systolic blood pressure among three study groups in different times
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Figure 2: Comparison of the means of systolic blood pressure among three study groups in different times

Mentions: A total of 95 children were recruited in the study. Five children were excluded. There were no significant differences in the demographic data, surgical duration, and distribution of surgical procedures in the three groups [Table 3]. Mean heart rate and systolic blood pressure values were summarized in Figures 1 and 2. In ketamine group, heart rate was significantly increased compared to midazolam and ketamine + midazolam groups. There were no significant differences among three groups regarding behavioral types, before premedication. After premedication, children's behavior type was significantly better in the combination group (P < 0.001). After anesthesia, behavior types were the same among three groups [Table 4]. Sedation scores before premedication were 5 and 6 for all children except for four children who had scores 3 and 4. Sedation among the groups was also significantly different after premedication and the combination group was significantly better sedated than the two other groups (P < 0.001) [Table 5]. There were no significant differences for extubation time and recovery time among three groups [Table 3].


Comparison of the effects of intravenous premedication: Midazolam, Ketamine, and combination of both on reducing anxiety in pediatric patients before general anesthesia.

Sajedi P, Habibi B - J Res Pharm Pract (2015 Oct-Dec)

Comparison of the means of systolic blood pressure among three study groups in different times
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645130&req=5

Figure 2: Comparison of the means of systolic blood pressure among three study groups in different times
Mentions: A total of 95 children were recruited in the study. Five children were excluded. There were no significant differences in the demographic data, surgical duration, and distribution of surgical procedures in the three groups [Table 3]. Mean heart rate and systolic blood pressure values were summarized in Figures 1 and 2. In ketamine group, heart rate was significantly increased compared to midazolam and ketamine + midazolam groups. There were no significant differences among three groups regarding behavioral types, before premedication. After premedication, children's behavior type was significantly better in the combination group (P < 0.001). After anesthesia, behavior types were the same among three groups [Table 4]. Sedation scores before premedication were 5 and 6 for all children except for four children who had scores 3 and 4. Sedation among the groups was also significantly different after premedication and the combination group was significantly better sedated than the two other groups (P < 0.001) [Table 5]. There were no significant differences for extubation time and recovery time among three groups [Table 3].

Bottom Line: We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia.After premedication, children's behavior was significantly better in the combination group (P < 0.001).Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more desirable behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Objective: In some medical circumstances, pediatric patients may need premedication for transferring to the operating room. In these situations, using intravenous premedication is preferred. We assessed the efficacy and safety of intravenous midazolam, intravenous ketamine, and combination of both to reduce the anxiety and improve behavior in children undergoing general anesthesia.

Methods: In a double-blind randomized clinical trial, 90 pediatric patients aged 6 months to 6 years with American Society of Anesthesiologist grade I or II were enrolled. Before anesthesia, children were randomly divided into three groups to receive intravenous midazolam 0.1 mg/kg, or intravenous ketamine 1 mg/kg, or combination of half doses of both. Behavior types and sedation scores were recorded before premedication, after premedication, before anesthesia, and after anesthesia in the postanesthesia care unit. Anesthesia time, recovery duration, blood pressure, and heart rate were also recorded. For comparing distribution of behavior types and sedation scores among three groups, we used Kruskal-Wallis test, and for comparing mean and standard deviation of blood pressure and heart rates, we used analysis of variance.

Findings: After premedication, children's behavior was significantly better in the combination group (P < 0.001). After anesthesia, behavior type was same among three groups (P = 0.421). Sedation scores among three groups were also different after premedication and the combination group was significantly more sedated than the other two groups (P < 0.001).

Conclusion: Combination of 0.05 mg/kg of intravenous midazolam and 0.5 mg/kg of intravenous ketamine as premedication produced more deep sedation and more desirable behavior in children compared with each midazolam 0.1 mg/kg or ketamine 1 mg/kg.

No MeSH data available.


Related in: MedlinePlus