Evaluating intranasal sufentanil-ketamine for preoperative sedation in children: A case-control study

Hospitalization and surgical procedures can cause significant emotional distress in children aged 3 to 7. This study aimed to assess the efficacy and safety of intranasal (IN) sufentanil-ketamine (SK) for preoperative sedation and evaluate parental satisfaction scores in children undergoing strabismus surgery under general anesthesia. This observational case study included sixty children aged 3 to 7 years with ASA physical status I/II at Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Participants were divided into two groups: those receiving IN SK group and those not receiving pre-anesthetic sedation (C group). The SK group received 0.5 µg/kg sufentanil and 0.5 mg/kg ketamine intranasally 20 min before anesthesia. Heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SpO2) were recorded at baseline and 15 min post-intervention. Sedation levels were assessed using the University of Michigan Sedation Scale (UMSS), and parental separation anxiety was evaluated using the Parental Separation Anxiety Scale (PSAS). There were no significant differences in demographics or baseline HR, SBP, and SpO2 between groups. However, the SK group had significantly higher sedation levels ( P < 0.001), with 83.4 % achieving satisfactory sedation compared to none in the C group. The SK group also had significantly more favorable parental separation scores ( P = 0.001). Side effects were minimal, with nausea and vomiting in only one patient (3.3 %) in the SK group. IN SK is effective and safe for preoperative sedation in children undergoing strabismus surgery. It provides satisfactory sedation and facilitates easier separation from parents with minimal side effects, making it a viable alternative for pediatric pre-anesthetic sedation.