Ketamine and midazolam as procedural sedation in children: a structured literature review and narrative synthesis

Abstract

In paediatric patients the alleviation of preoperative anxiety is key to ensuring a smooth anaesthetic, and studies have shown that a pleasant induction is able to prevent adverse postoperative behavioural changes. Oral midazolam and ketamine in combination have been used as premedication to ameliorate this anxiety, but the utility of this combination remains unclear. The authors conducted a systematic review and narrative synthesis of randomised controlled trials testing the effectiveness of the combination of oral midazolam and ketamine versus midazolam alone as preanaesthetic sedation in children aged one to 15 years of age undergoing elective paediatric surgery. Ten trials were included in this analysis. Trials using combinations of midazolam (0.25 to 0.3 mg.kg-1) and ketamine (2 to 3 mg.kg-1) provided higher quality sedation with a similar or better side-effect profile than midazolam 0.5 mg.kg-1 alone, without prolonging recovery time.