The preanesthetic management of preschool children is rather difficult. They worry about separation from their parents, the strange hospital environment, surgery, and are not always amenable to reasoned explanation. Therefore, the preoperative
sedation
is necessary to reduce anxiety and minimize psychologic trauma to children.
To determine which type of intrarectal administration is the most effective in preanesthetic sedation, 90 children were randomly assigned to three groups.
Group Ⅰ was administered with intrarectal midazolam (0.5 mg/kg), group Ⅱ, intrarectal ketamine (5 mg/kg), and group Ⅲ, intrarectal midazolam (0.5 mg/kg) with ketamine (5 mg/kg). Most of children separated easily form their parents 30 minutes
after
intrarectal administration (above 80%). In all groups, the loss of consciousness were below 40% and sedation states were above 80%. But in group Ⅲ, the loss of consciousness and the sedation states were much better than those of the other two
groups.
The anxiety level of group Ⅲwas lower than that of the other groups (p<0.05) and the sedation level of group Ⅰand Ⅲwere better than that of group Ⅱ(p<0.001). Complications and recovery time were similar among each group. Following intrarectal
administration of 0.5 mg/kg of midazolam with 5 gm/kg of ketamine, reliable sedation was obtained 20-30 min after intrarectal administration.
Therefore we believe that intrarectal midazolam with ketamine is a useful technique for the reliable preoperative sedation in children.
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