Key result
A low-dose combination of oral ketamine and midazolam achieved an acceptable sedation score at 20 minutes in 54% of children, compared to 21% with midazolam and 16% with ketamine alone.
Why the study?
Does a low dose combination of oral midazolam and ketamine improve sedation onset and recovery compared to either drug alone in children undergoing elective ophthalmic surgery?
RCT (n=78)
Does a low dose combination of oral midazolam and ketamine improve sedation onset and recovery compared to either drug alone in children undergoing elective ophthalmic surgery?
A low-dose combination of oral ketamine and midazolam provides faster onset of sedation and more rapid recovery with minimal side effects compared to higher doses of either drug alone for premedication in children.
Answers are grounded in this paper and cite their sources.
Supports low-dose ketamine-midazolam for faster pediatric sedation; extends monotherapy trials to additive efficacy in ophthalmic surgery.
This randomized controlled trial was designed to evaluate whether the combination of low dose oral midazolam (0.25 mg/kg) and low dose oral ketamine (3 mg/kg) provides better premedication than oral midazolam (0.5 mg/kg) or oral ketamine (6 mg/kg). Seventy-eight children of ASA physical status I or II scheduled for elective ophthalmic surgery were randomly divided into three groups and given premedication in the holding area 30 minutes before surgery. Two subjects from each group vomited the medication and were excluded, leaving 72 subjects for further analysis. The onset of sedation was earlier in the combination group than the other two groups. At 10 minutes after premedication 12.5% in the combination group had an acceptable sedation score compared with none in the other two groups. After 20 minutes 54% in the combination group had an acceptable sedation score, 21% in the midazolam group and 16% in the ketamine group (P<0.05). There were no significant differences in the parental separation score, response to induction and emergence score. The mean time for best parental separation score was significantly less in the combination group (19+/-8 min) than either the midazolam (28+/-7) or ketamine (29+/-7 min) groups (P<0.05). Recovery was earlier in the combination group, as the time required to reach a modified Aldrete score of 10 was significantly less in the combination group (22+/-5 min) than in the oral midazolam (36+/-11 min) or ketamine (38+/-8 min) groups. The incidence of excessive salivation was significantly higher in the ketamine alone group (P<0.05). In conclusion, the combination of oral ketamine (3 mg/kg) and midazolam (0.25 mg/kg) has minimal side effects and gives a faster onset and more rapid recovery than ketamine 6 mg/kg or midazolam 0.5 mg/kg for premedication in children.
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Darlong et al. (2004) conducted an RCT in Premedication for elective ophthalmic surgery (n=78). Low dose combination of oral midazolam and oral ketamine vs. oral midazolam (0.5 mg/kg) or oral ketamine (6 mg/kg) was evaluated on Acceptable sedation score at 20 minutes (p=<0.05). A low-dose combination of oral ketamine and midazolam achieved an acceptable sedation score at 20 minutes in 54% of children, compared to 21% with midazolam and 16% with ketamine alone.
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