Oral Ketamine Premedication for Pediatric Outpatient Anesthesia

Lee, Ki Young; Shin, Yang Sik; Lee, Choon Soo; Park, Ki Yong; Lee, Dong Chul; Kim, Jong Rae; Han, Seok Joo; Hwang, Eui Ho

Abstract

BACKGROUND: In children, fear of venipuncture and seperation from parents may produce stormy induction of anesthesia. Premedication administered by nontraumatic methods helps to decrease anxiety and minimize psychological trauma.
METHODS
To define a dose of oral ketamine that would facilitate smooth induction of anesthesia for pediatric outpatient surgery without causing significant side effects, sixty children(ASA Physical Status 1; aged 1-7 years) undergoing inguinal herniorrhaphy were assigned randomly to four separate groups that received 5 mg/kg, 7 mg/kg, 10 mg/kg, or no ketamine(control group) mixed in 0.2 ml/kg cola. They were evaluated preoperatively and postoperatively for acceptance of oral ketamine, reaction to separation from their parents, acceptance of facial mask for inhalation induction, emergence delirium and postanesthetic complications.
RESULTS
The 7 mg/kg and 10 mg/kg doses were well accepted; provided predictable sedation within 22-25 minutes; allowed calm seperation from parents and good induction conditions. However, the 10 mg/kg dose prolonged discharge time from recovery room, probably due to delayed recovery. Emergence deliriums were observed in two of all ketamine administered children(4.4%). And the incidences of postanesthetic complications such as vomiting, decreased appetite, lethargy, nausea, nightmare, behavioral change were slightly higher in ketamine administered groups, compared to the control group.
CONCLUSION
The authors conclude that an oral dose of 7 mg/kg ketamine is well accepted in young children undergoing outpatient surgery for inguinal hernia and provides relatively predictable and satisfactory sedation without prolongation of discharge time and significant side effects.