Oral midazolam plus ketamine compared to midazolam only to reduce agitation in children undergoing urological surgery after sevoflurane anesthesia

Abstract

Background and objectives: Sevoflurane is widly used in pediatric anesthesia as children tolerate it well, but it often gives postoperative agitation. The objective of this study was to test the effect of small doses of ketamine together with midazolan in reducing agitation from sevoflurane in children.

Methodology: We enrolled 80 children from 3-10 years old, undergoing urological surgery under general anesthesia, in this randomized double blind prospective study. Participants were randomly divided into two groups. The first group (Group M) received midazolam 0.5 mg/kg orally and the second group (Group KM) received oral midazolam plus ketamine 2 mg/kg. For general anesthesia, we used sevoflurane. Induction was done with fentanyl, thiopental and sexamethonium and then the patient was intubeted.  Five different levels were used to measure the degree of agitation. Agitation was managed by fentanyl 1 µg/kg IV and total dose used was noted.

Results: The demographic data were statistically equivalent in both groups. There was no significant difference between two groups regarding awakening period or hospital discharge. Patients in Group KM had a significantly lower agitation score compared to Group M. (Mann Whitney T=15; p<0.01). Fentanyl consumption was significantly greater in Group M compared to the Group KM.

Conclusion: Adding small doses of ketamine by mouth beside midazolam reduces episodes of agitation after sevoflurane anesthesia in children undergoing urology procedures without delaying hospital discharge.

Citation: Gani H, Beqiri V, Prifti P, NacoM, Domi R, Janushaj O, Hoxha B. Oral midazolam plus ketamine compared to midazolam only to reduce agitation in children undergoing urological surgery after sevoflurane anesthesia. Anaesth Pain & Intensive Care 2014;18(3):237-240