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Comparison of the effects of intranasal midazolam versus different doses of intranasal ketamine on reducing preoperative pediatric anxiety: a prospective randomized clinical trial

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Abstract

Purpose

To compare the effects of intranasal midazolam versus different doses of intranasal ketamine on reducing preoperative pediatric anxiety.

Methods

The participants of this double-blinded clinical trial study consisted of 120 children aged between 2 and 8 years. They were chosen for elective surgery and randomly assigned to four equal groups. For reducing preoperative anxiety, in the first group midazolam 0.2 mg/kg, in the second group (K1) ketamine 0.5 mg/kg, in the third group (K2) ketamine 3 mg/kg, and in the fourth group normal saline 1 drop/5 kg were administered intranasally. After 15 min, severity of anxiety was assessed with the modified Yale preoperative anxiety score (m-Yale PAS), and level of sedation was evaluated by the Ramsay Sedation Scale before intravenous catheterization. All data were transferred to SPSS-10 software and analyzed statistically with ANOVA, Kruskal–Wallis, and Mann–Whitney tests. A p value < 0.05 was considered meaningful.

Results

The mean of m-Yale PAS in midazolam group was significantly lower than the other three groups (p < 0.05). Regarding this score, there was no significant statistical difference between K2 and normal saline groups (p = 0.944), but the differences between K1 and K2 (p = 0.034) and also between K1 and normal saline (p = 0.049) groups were significant statistically. The Ramsay Sedation Scale in the midazolam group was significantly higher than the other three groups (p < 0.05). By this scale, there was no significant statistical difference between (K2) and normal saline groups (p = 0.940). The differences between (K1) and normal saline (p = 0.045) and also between (K1) and (K2) groups (p = 0.009) were significant statistically.

Conclusion

Intranasal midazolam was more effective than low- or high-dose intranasal ketamine in reducing preoperative pediatric anxiety. The lower dose of ketamine reduced preoperative anxiety more than a higher dose of ketamine, which may be clinically insignificant.

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Acknowledgments

The authors thank Nahid Hosseini Jahromi and Mohammad Mehravaran for their valuable help in this study. We are also grateful to those parents who gave permission to provide their children as examples in this study.

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Authors and Affiliations

  1. Department of Anesthesiology, Qazvin University of Medical Sciences, Qazvin, Iran

    S. A. Hosseini Jahromi & S. M. Hosseini Valami

  2. Department of Anesthesiology, Mazandaran University of Medical Sciences, Sari, Iran

    Nematollah Adeli

  3. Department of Social Medicine, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

    Zohreh Yazdi

  4. Department of Anesthesiology, Shahid Rajaee Hospital, Qazvin, Iran

    S. M. Hosseini Valami

Authors
  1. S. A. Hosseini Jahromi
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  2. S. M. Hosseini Valami
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  3. Nematollah Adeli
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  4. Zohreh Yazdi
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Corresponding author

Correspondence to S. M. Hosseini Valami.

Additional information

The clinical trial registration number is IRCT201104236254N1.

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Hosseini Jahromi, S.A., Hosseini Valami, S.M., Adeli, N. et al. Comparison of the effects of intranasal midazolam versus different doses of intranasal ketamine on reducing preoperative pediatric anxiety: a prospective randomized clinical trial. J Anesth 26, 878–882 (2012). https://doi.org/10.1007/s00540-012-1422-6

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  • DOI: https://doi.org/10.1007/s00540-012-1422-6

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