Comparison of the effectiveness of two different combinations of oral ketamine and midazolam premedication in autistic children

Abstract

Objective: Effective premedication is one of the key factors for anesthetic management of autistic children. We designed a study protocol to compare two different dose regimens of midazolam plus ketamine for premedication of autistic children. Methods: We performed a prospective randomized double-blind study in 142 autistic children, aged 1-17 years, undergoing brain SPECT imaging procedure. Group I received oral 0.5 mg/kg midazolam with 3 mg/kg ketamine and Group II received oral midazolam 0.25 mg/kg with ketamine 6 mg/kg. Onset of sedation and sedation score just before the induction of anesthesia were recorded. Anxiety of children was assessed by a four point scale at admittance, during separation from parents and at venipuncture. Post-anesthetic recovery was assessed using the modified Aldrete score. Postoperative vomiting and any other side effects were recorded when seen. Ten days after the procedure, parents were interviewed for changes in behaviors, sleep disturbances and feeding difficulties. Results: Acceptable sedation scores were obtained in both groups. Success rates for parental separation and intravenous cannulation were higher than 85% in both groups. There were no differences between two groups in terms of sedation onset time, intravenous cannulation anxiety score, parental separation anxiety score, side effects and changes in behaviors, sleep disturbances and feeding difficulties. The only significant difference between two groups is sedation scores before induction of anesthesia. Children in high ketamine group had deeper sedation state than those in the other group. Conclusion: Our results showed that both dose regimens provided successful premedication in autistic children.

Keywords

• Oral, premedication, midazolam, ketamine, autism

Otistik çocuklarda iki farklı oral ketamin+midazolam premedikasyonunun etkilerinin karşılaştırılması

Öz

Amaç: Otistik çocukların anestezi yönetiminde etkin bir premedikasyon hayati önem taşır. Çalışmamızda otistik çocuklarda premedikasyon amacıyla kullanılan iki farklı midazolam+ketamin kombinasyonunun etkileri karşılaştırılmıştır. Yöntem: Prospektif, randomize ve çift-kör olan bu çalışmaya beyin SPECT görüntüleme yöntemi uygulanabilecek yaşları 1-17 arasında 142 otistik çocuk dâhil edilmiştir. 1. gruba 0.5 mg/kg midazolam + 3 mg/kg ketamin, 2. gruba ise 0.25 mg/kg midazolam + 6 mg/kg ketamin oral yoldan verilmiştir. Sedasyon başlama süresi ve anestezi indüksiyonu öncesi sedasyon skoru kayıt edilmiştir. Çocuklarda başlangıçta, aileden ayrılırken ve damar yolu açılırken anksiyete dörtlü bir skala ile, anestezi sonrası derlenme ise modifiye Aldrete skoru ile değerlendirilmiştir. Postoperatif dönemde bulantı ve benzeri yan etkiler kayıt edilmiştir. İşlemden 10 gün sonra hasta yakınları aranmış ve davranış değişiklikleri, uyku bozuklukları ve beslenme sorunları açısından sorgulanmıştır. Bulgular: Her iki grupta da kabul edilebilir sedasyon skorları elde edilmiş, aileden ayrılma ve intravenöz kanülasyonda %85'in üstünde başarı elde edilmiştir. Sedasyon başlangıç süresi, aileden ayrılma, intravenöz kanülasyonda anksiyete skorları, yan etkiler, postoperatif davranış değişiklikleri ve beslenme sorunları açısından iki grup arasında bir fark bulunmamıştır. Gruplar arasında tek anlamlı fark, indüksiyon öncesi sedasyon skorunda tespit edilmiş, yüksek doz ketamin içeren grupta daha derin bir sedasyon düzeyi sağlanmıştır. Sonuç: Her iki rejimin de otistik çocuklarda başarılı premedikasyon sağladığı görülmüştür.

Anahtar Kelimeler

• Oral, premedikasyon, midazolam, ketamin, otizm

Kaynakça

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