This premedication has been reported to produce effective preoperative sedation and facilitation of induction of anesthesia in children. While an excellent analgesic, transmucosal fentanyl may causes pruritus and postoperative nausea and vomiting. Because of the excellent analgesic properties of this drug, it may be that its best use is in burn units and emergency departments rather than in the preoperative settings. Ketamine is especially useful as a premedication agent for uncooperative patients. Given intramuscularly, it acts rapidly, usually causing loss of consciousness in less than five minutes.
Ketamine stimulates the cardiovascular system, increasing heart rate and blood pressure.
It preserves airway reflexes, but secretions, blood or gastric regurgitant can trigger laryngospasm. An antisialagogue should be given simultaneously to minimize secretions. Ketamine can also be given intranasally and transmucosally in the form of a lollipop. Finally, parents should be apprised of the appearance of the dissociative state produced by ketamine. In conclusion, based on the clinically important outcomes that are outlined in this article, the issue of anxiety in children should not be ignored by anesthesiologists.