Intranasal Ketamine for Premedication in Children: A Comparative Study in Ghana

Abstract

BACKGROUND: Premedication is helpful especially in children in reducing the stress associated with anesthesia and surgery. Pediatric patients for surgery in Korle Bu Teaching Hospital are currently not sedated preoperatively due to unavailability of effective pediatric sedative preparations. Ketamine is readily available, inexpensive, and has been used for pediatric sedation through various routes with good outcomes in other geographical regions. Its intra-nasal use shows promise and avoids the anxiety and pain associated with establishing of an intravenous access and administration of drugs intravenously and intramuscularly. AIM: The aim of this study was to assess the efficacy of intranasal ketamine as premedication for pre-operative sedation. MATERIALS AND METHODS: A double-blind, randomized, and controlled trial was conducted on 76 pediatric elective surgical patients aged between 1 and 6 years at the Korle-Bu Teaching Hospital. Subjects were randomly assigned to receive 10 mg/kg intranasal ketamine (Treatment group) or 0.9% normal saline (Control group) 30 min before induction of anesthesia. Ease of separation from parents was assessed before (Pre-intervention) and 30 min after administration of intranasal solution (Postintervention). The level of sedation and acceptance of face mask were assessed 30 min after intranasal administration. RESULTS: The mean separation score in the treatment group was significantly lower pre-intervention (p = 0.026) but significantly higher 30 min post-intervention compared to control group (p < 0.0001). There was a significantly higher mean sedation score (2.8 ± 0.8 vs. 1.7 ± 0.7; p < 0.0001) and face mask acceptance score (3.4 ± 0.8 vs. 1.9 ± 1.2; p < 0.0001) among the treatment group compared to the control group. The incidence of salivation was significantly higher among the treatment group compared to the control group (17.9% vs. 0%; p = 0.007). CONCLUSION: The use of intranasal ketamine as premedication preoperatively in pediatric surgical patients is safe and results in improved sedation scores, better separation scores, and acceptance of face mask.