Comparative Assessment of anxiety relief and ease of Parental Separation in Children undergoing Herniotomy with Oral Ketamine, Midazolam, or Combined Ketamine-Midazolam Premedication before General Anaesthesia: A Randomized Controlled Study

Introduction: Premedication is important to allay anxiety, produce sedation, and facilitate the smooth induction of anaesthesia, especially in children undergoing procedures or surgeries under general anaesthesia. However, there remains debate over the optimal drug or drug combination. This study aimed to compare the effectiveness of oral ketamine or oral midazolam alone versus combination oral ketamine and oral midazolam as paediatric premedication in children undergoing herniotomy under general anaesthesia in our tertiary centre. Methods: The study was a prospective, randomised study involving 129 consented paediatric patients aged 1 to 8 years scheduled for day surgery. Subjects were divided into three groups: group M received 0.5mg/kg of midazolam, group K received 5mg/kg of ketamine, while group K+M received a mixture of 0.3mg/kg midazolam and 3mg/kg ketamine. Sedation and ease of separation scores were measured with a 4-point sedation score and ease of separation score, respectively. Results: The level of sedation varied significantly across the groups at all time intervals (p <0.001). More subjects in the K+M group had statistically significantly better sedation and satisfactory ease of parental separation scores compared to the other groups. Conclusion: Our study revealed that combinations of oral ketamine and oral midazolam provided a more satisfactory level of pre-operative sedation and ease of parental separation than oral midazolam or oral ketamine alone in paediatric patients undergoing herniotomy under general anaesthesia. Unavailability of the bispectral index, which hindered the proper monitoring of the depth of sedation, was a limitation in our study.