The Effect of Premedication with Intrarectal Ketamine and Midazolam in Children

Ye, Woon Hae; Chung, Chan Jong; Chin, Young Jhoon

Abstract

The preanesthetic management of preschool children is rather difficult. They worry about separation from their parents, the strange hospital environment, surgery, and are not always amenable to reasoned explanation. Therefore, the preoperative sedation is necessary to reduce anxiety and minimize psychologic trauma to children. To determine which type of intrarectal administration is the most effective in preanesthetic sedation, 90 children were randomly assigned to three groups. Group I was administered with intrarectal midazolam (0.5 mg/kg), group II, intrarectal ketamine (5 mg/kg), and group III, intrarectal midazolam (0.5 mg/kg) with ketamine (5 mg/kg). Most of children separated easily from their parents 30 minutes after intrarectal administration (above 80%). In all groups, the loss of consciousness were below 40% and sedation states were above 80%. But in group III, the loss of consciousness and the sedation states were much better than those of the other two groups. The anxiety level of group III was lower than that of the other groups (p<0.05) and the sedation level of group I and III were better than that of group II (p<0.001). Complications and recovery time were similar among each group. Following intrarectal administration of 0.5 mg/kg of midazolam with 5 mg/kg of ketamine, reliable sedation was obtained 20-30 min after intrarectal administration. Therefore we believe that intrarectal midazolam with ketamine is a useful teehnique for the reliable preoperative sedation in children.