Kolathu Parambil Radhika, Konnanath T. Ramadas
BACKGROUND In paediatric anaesthesia a good premedication is essential to reduce anxiety and agitation in children. Parental separation and strange operating room environment usually result in stormy induction while providing general anaesthesia. Sedative premedication is essential to make children calm and co-operative in the strange environment. The aim of this study was to compare the efficacy of orally administered midazolam 0.5 mg/Kg, ketamine 5 mg/Kg and triclofos sodium 100 mg/Kg in children prior to induction of general anaesthesia for minor elective surgical procedures. MATERIALS AND METHODS A total of 180 children of both genders aged 1-8 years and American Society of Anesthesiologists (ASA) physical status I-II scheduled for minor elective surgical procedures under general anaesthesia were enrolled in this prospective randomized controlled trial. Patients were randomly allocated to receive oral midazolam (Group M, n=60), ketamine (Group K, n=60) and oral triclofos sodium (Group T, n=60). Group M children were premedicated with oral midazolam syrup 0.5 mg/Kg. 45 minutes prior to induction, Group K children were premedicated with oral ketamine syrup 5 mg/Kg and Group T children were premedicated with triclofos sodium syrup 100 mg/Kg 45 minutes prior to induction of anaesthesia. All children received oral atropine 0.04 mg/Kg 45 minutes before induction of anaesthesia. All children were evaluated for behaviour in the operating room environment during face mask placement for induction of general anaesthesia. The adverse effects related to each drug were recorded for 24 hour post operatively. Setting and Design- Randomized controlled study. Statistical Analysis- Pearson chi square test was used for qualitative data and Kruskal-Wallis test for qualitative or semi qualitative data. Kruskal-Wallis test was used to compare the behaviour of children in the operating room while placing the face mask for induction of general anaesthesia. Significance level was set at a p value of <0.001. RESULTS Children of all three groups were cooperative during induction of general anaesthesia. Cooperation score was assessed by acceptance of face mask by children before induction of anaesthesia. It was observed that 75% children were very cooperative with a score of 1 in oral ketamine group, 80% were very cooperative with a score of 1 in oral midazolam group and 90% were very cooperative with a score of 1 in oral triclofos sodium group (p=0.097). Even though we observed a difference between these groups clinically, during placement of mask before induction of anaesthesia the difference found was not statistically significant. The cooperation scores were comparable and satisfactory in all the three groups. No adverse effects were noted in children premedicated with oral midazolam and oral triclofos groups. But vomiting and abnormal movements were observed in two children premedicated with oral ketamine. CONCLUSION Oral midazolam, triclofos, and ketamine were effective in children before induction of general anaesthesia. Children accepted face mask and allowed smooth induction of general anaesthesia inside the operating room. All the three oral premedicants demonstrated comparable behaviour in the strange operation room environment. All the three premedicants are good and safe in paediatric anaesthesia.
