Comparison of Intranasal Ketamine with Midazolam as Premedication in Children

Objective: To compare the efficacy of Ketamine and Midazolam in terms of early sedation, with better five-point sedation scores, easy intravenous access, recovery time, and safety in terms of hemodynamic stability, and minimum complications rate when administered intranasal for pediatric premedication.  Methodology: This randomized clinical trial  was conducted in Department of Anesthesia, Sahiwal Teaching Hospital form March 2023 to February 2024. Total 132 patients aged 2-10 years with ASA physical statuses I or II scheduled for elective surgery under general anesthesia. They were randomly assigned to Group K (n=66) receiving 3mg/kg of ketamine and Group M (n=66) receiving 0.1mg/kg of midazolam 30 minutes before anesthesia induction, administered intranasally. Results: Most  patients in both groups had an alert five-point sedation scale, 22 (33.3%) and 22 (33.3%). (p=0.644). The mean onset of sedation for the ketamine and midazolam groups was 14.72±2.01 and 11.43±1.34, respectively. (p<0.001). The most common venipuncture score in the ketamine and midazolam group was grade II, 27 (40.9%) and 39 (59.1%), respectively. (p=0.012). In the ketamine and midazolam groups, the readily was the most common acceptance of mask before induction, 31 (47.0%) and 36 (54.5%), respectively. (p=0.362). Conclusion: Midazolam is a better choice for premedication as its rapid onset of sedation characterizes it and facilitates smooth intravenous access with minimal resistance, ensuring patient hemodynamic safety. Additionally, it is associated with a short recovery time and fewer side effects, representing its safety profile.