Document Type : original article

Authors

1 Department of Anesthesiology and critical care, Mazandaran university of Medical sciences, Sari, Iran

2 Department of Anesthesiology and operating room, Faculty of Allied medical science, Mazandaran university of Medical sciences, Sari, Iran

3 Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

4 Assistant Professor of Anesthesiology and critical care, Mazandaran university of medical sciences, Sari, Iran

Abstract

Background: Fear and anxiety before entering the operating room are significant issues in pediatric anesthesia. Given that the venipuncture process is accompanied by separation anxiety, and the ease of use of intranasal premedication versus intravenous, rectal, or intramuscular methods, and considering the risk of aspiration during oral delivery in children, the purpose of this study was to compare and contrast the anti-anxiety and sedation effects of intranasal midazolam and intranasal ketamine as a premedication in pediatric hernia repair surgery.
Methods: This was a double-blind randomized clinical trial involving 36 participants aged 1 to 6 years who underwent hernia repair surgery in Bu Ali Hospital between 2020 and 2021. The child was transferred to the operating room after 30 minutes of evaluating the effects of the drug and recording the related data. In the operating room, data from an electrocardiogram device, arterial oxygen saturation level, and blood pressure were all checked. At 5 minute intervals, the patient's hemodynamics were checked and recorded. The time from the beginning to the end of anesthesia was recorded.
Results: This study included 36 patients (18 in each group). The average age and weight of the patients were 37.71 ± 21.73 months (range = 1-72 months) and 14.60 ± 4.26 kg (range = 6.5-25 kg), respectively. Independent t-tests showed no significant difference between the two groups. Heart rate and blood pressure were measured in two groups (ketamine and Midazolam) but no significant difference was observed among the three stages (before premedication, before anesthesia, and after intubation) (P>0.05). The relationship between qualitative outcomes was analyzed using Chi-square test but no significant difference was observed.
Conclusion: the current study showed that there is no statistically significant difference between intranasal ketamine and midazolam in terms of effectiveness and side effects.

Keywords

  1. Chandrakala N. A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam in Pediatric Elective Surgeries: Coimbatore Medical College, Coimbatore; 2020.
  2. Chakraverty P, Naz A, Roy S. Intranasal midazolam versus intranasal ketamine as premedication in pediatric patients: A comparative study. 2020.
  3. Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: a comparison of intranasal dexmedetomidine versus oral midazolam. Saudi journal of anaesthesia. 2011; 5(4):387.
  4. Cao J, Shi X, Miao X, Xu J. Effects of premedication of midazolam or clonidine on perioperative anxiety and pain in children. Biosci Trends. 2009; 3(3):115-8.
  5. Rosenbaum A, Kain ZN, Larsson P, LÖNNQVIST PA, Wolf AR. The place of premedication in pediatric practice. Pediatric Anesthesia. 2009; 19(9):817-28.
  6. Dave NM. Premedication and induction of anesthesia in pediatric patients. Indian Journal of Anaesthesia. 2019; 63(9):713.
  7. Pacifici GM. Clinical pharmacology of midazolam in neonates and children: effect of disease—a review. International journal of pediatrics. 2014; 2014.
  8. Mayel M, Nejad MA, Khabaz MS, Bazrafshani MS, Mohajeri E. Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial. Turkish Journal of Emergency Medicine. 2020; 20(4):168.
  9. Fitzgibbons Jr RJ, Forse RA. Groin hernias in adults. New England Journal of Medicine. 2015; 372(8):756-63.
  10. Ben Abacha A, Demner-Fushman D. A question-entailment approach to question answering. BMC bioinformatics. 2019; 20(1):1-23.
  11. Carne P, Robertson G, Frizelle F. Parastomal hernia. Journal of British Surgery. 2003; 90(7):784-93.
  12. Kapiris S, Brough W, Royston C, O’Boyle C, Sedman P. Laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Surgical endoscopy. 2001; 15(9):972-5.
  13. Lau H, Fang C, Yuen WK, Patil NG. Risk factors for inguinal hernia in adult males: a case-control study. Surgery. 2007; 141(2):262-6.
  14. Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O'Dwyer PJ. Groin hernia repair in Scotland. British journal of surgery. 2000; 87(12):1722-6.
  15. Qiao H, Xie Z, Jia J. Pediatric premedication: a double-blind randomized trial of dexmedetomidine or ketamine alone versus a combination of dexmedetomidine and ketamine. BMC anesthesiology. 2017; 17(1):1-7.
  16. Yuen VM, Hui TW, Irwin MG, Yuen MK. A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trial. Anesthesia & analgesia. 2008; 106(6):1715-21.
  17. Bergendahl H, Lönnqvist P-A, Eksborg S. Clonidine: an alternative to benzodiazepines for premedication in children. Current opinion in anesthesiology. 2005; 18(6):608-13.
  18. Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine in pediatric anesthesia: review of the literature and comparison with benzodiazepines for premedication. Acta anaesthesiologica scandinavica. 2006; 50(2):135-43.
  19. Garcia-Velasco P, Roman J, Beltrán de Heredia B, Metje T, Villalonga A, Vilaplana J. Nasal ketamine compared with nasal midazolam in premedication in pediatrics. Revista Espanola de Anestesiologia y Reanimación. 1998; 45(4):122-5.
  20. Sonal S K, Rochana G B. Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children. 2014.
  21. Narendra P, Naphade RW, Nallamilli S, Mohd S. A comparison of intranasal ketamine and intranasal midazolam for pediatric premedication. Anesthesia, essays and researches. 2015; 9(2):213.
  22. Bahetwar S, Pandey R, Saksena A, Girish C. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. Journal of Clinical Pediatric Dentistry. 2011; 35(4):415-20.
  23. Khoshrang H, Alavi CE, Rimaz S, Mirmansouri A, Farzi F, Biazar G, Atrkarroushan Z, Sabet Khadem N. Efficacy of intranasal ketamine and midazolam for pediatric sedation: A double-blind, randomized clinical trial. Caspian Journal of Internal Medicine. 2021; 12(4):539.