Comparison of Oral Midazolam and Oral Ketamine as Premedicants for Parent–Child Separation in Paediatric Elective Surgery

Introduction: Preoperative anxiety in children undergoing surgery can adversely affect parent–child separation, induction of anaesthesia, and postoperative behavioural outcomes. Oral premedication is widely used in paediatric anaesthesia as it is non-invasive and well accepted. Midazolam and ketamine are the commonly employed oral premedicants, each with distinct pharmacological profiles. Materials and Methods: This prospective randomized double-blinded comparative study was conducted in a tertiary care hospital and included 66 children aged 1– 6 years belonging to ASA physical status I and II, scheduled for elective surgical procedures. Children were randomly allocated into two equal groups: Group M received oral midazolam 0.5 mg/kg and Group K received oral ketamine 5 mg/kg, both mixed with paracetamol syrup for palatability. Sedation scores, heart rate, and oxygen saturation were recorded at baseline and at 0, 5, 10, 15, and 20 minutes after premedication. Results: Baseline demographic data such as weight and age were comparable between the two study groups. Oxygen saturation and Heart rate remained stable throughout the observation period at any point of time, in both the groups with no statistically significant differences. Conclusion: Both the oral ketamine and oral midazolam provided good sedation and maintained the expected hemodynamic stability in the paediatric patients. However, oral midazolam had better behavioural outcomes during parent–child separation and lesser adverse effects, suggesting that it may be the preferred oral premedicant for elective surgical procedures in children.