Comparison Between Dexmeditomidine, Midazolam and Ketamine as a Sedative to Help Cannula Insertion in Pediatric Patient
Condition: Cannula Site Pain
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      Background and Objectives: Surgery and hospitalization present a very stressful period for
      children and their parents. The induction of anesthesia and cannula insertion may be the only
      bad experience a child can remember during his procedure. Pediatric intravenous cannulation
      is technically difficult and moreover may cause psychological problems. Sedative
      Premedication has a great role in pediatric anesthesia to overcome fear and anxiety and to
      facilitate easy separation from their parents. Intranasal approach is safe and painless and
      well tolerated by children in addition to a comparable onset of action with the intravenous
      approach. Midazolam, dexmedetomidine and ketamine have proved their effectiveness as a
      sedative premedication. The objective of the current study was to compare the effectiveness
      of administration of intranasal midazolam, dexmedetomidine and ketamine as sedatives to
      facilitate and decrease the discomfort of intravenous cannulation before surgery in children
      undergoing various surgical procedures. Methods: the patients agreed to participate in the
      research were classified into 3 groups. Dexmedetomidine, Midazolam and Ketamine group; each
      group received the intranasal drug 30 min before the procedure. Pulse, MAP, oxygen saturation
      and sedation score (MOAA/S) baseline and every 10 min. Easiness of venipuncture, parental
      separation and any complication encountered were recorded.
    

Detailed description: 
      Background and Objectives: Surgery and hospitalization present a very stressful period for
      children and their parents. The induction of anesthesia and cannula insertion may be the only
      bad experience a child can remember during his procedure. Pediatric intravenous cannulation
      is technically difficult and moreover may cause psychological problems. Sedative
      Premedication has a great role in pediatric anesthesia to overcome fear and anxiety and to
      facilitate easy separation from their parents. Intranasal approach is safe and painless and
      well tolerated by children in addition to a comparable onset of action with the intravenous
      approach. Midazolam, dexmedetomidine and ketamine have proved their effectiveness as a
      sedative premedication. We assumed that intranasal midazolam, dexmedetomidine and ketamine
      would help anesthetics to carry out venous cannulation easily; in addition to their sedative
      premedication effect.

      The objective of the current study was to compare the effectiveness of administration of
      intranasal midazolam, dexmedetomidine and ketamine as sedatives to facilitate and decrease
      the discomfort of intravenous cannulation before surgery in children undergoing various
      surgical procedures.

      Study design: 150 patients agreed to participate in the research after written informed
      consent. patients were classified into 3 groups. Dexmedetomidine, Midazolam and Ketamine
      group; each group received the intranasal drug 30 min before the procedure. Pulse, MAP,
      oxygen saturation and sedation score (MOAA/S) baseline and every 10 min. Easiness of
      venipuncture, parental separation and any complication encountered were recorded. Group
      assignment, preparation and administration of drugs will be performed by a junior anesthetist
      who is neither involved nor interested by any means in the study.
    

Intervention name(s): Ketamine; Midazolam; Dexmedetomidine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): ketamine intranasal injection,2 mg/kg, once, 30 min preoperative; midazolam intranasal injection,0.2mg/kg, once, 30 min preoperative; dexmedetomidine intranasal injection,1 μg/kg, once, 30 min preoperative
Other intervention name(s): ket; mid; dex
Intervention MeSH terms: Midazolam; Dexmedetomidine; Ketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: dexmedetomidine; ketamine; midazolam