NASAL LOW DOSE KETAMINE COMBINED WITH MIDAZOLAM FOR PAEDIATRIC PREMEDICATION
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Sixty Children aged from three to six years scheduled for tonsillectomy or bilateral insertion of tympanotomy tubes under general anaesthesia, were studied. The patients were randomly allocated into two groups where group (A) received a combination ofintranasal ketamine (2 mg/kg) and midazolam (o.l mg/kg) and group IB) received placebo (normal sa line). Anaesthesia was induced with 5% halothane and 100% Og via face mask, subjects given intranasal combination ofketamine-midazolam were more likely to separate willingly from their parents at or before 10 min utes compared to patients given placebo. 60% of patients given this combi nation separated at 4 minutes compared to 20% of patients given placebo. The quality of subsequent halothane inductionwas excellent in 70% of pa tients given this combination and adequate in the remaining 30%. In 70% of patients given placebo induction was unacceptable. There were no inch dents of any behavioral changes or psychological disturbances in patients given this intranasal combination. No statistically significant difference as regards recovery time was recorded bettbeen both groups. It can be con cluded that nasal low dose ketamine combined with midazolam provides an effective paediatric premedication with regard to sedation and mask acceptance. It has'rapid action with no prolongation of recovery time and no instances of emergence phenomena. Nasal ketamine- midazolam com bination offers an altevnative to intramuscular'or per rectum routes for preanaethetic sedation in young children aged from three to six years .