Comparative evaluation of intranasal midazolam, dexmedetomidine, ketamine for their sedative effect and to facilitate venous cannulation in pediatric patients: A prospective randomized study

Background Sedative premedication has a great role to overcome fear and anxiety and to facilitate easy separation of children from their parents. The current study was designed to compare the effectiveness of intranasal midazolam, dexmedetomidine, and ketamine as sedatives to facilitate the intravenous cannulation before surgery in children. Methods The patients were classified into three groups. M group (midazolam), D group (dexmedetomidine), and K group (ketamine), each group received the intranasal drug 30 min before the procedure. The degree of sedation was documented using Modified Observer's Assessment of Alertness/Sedation scale (MOAA/S) at baseline and every 10 min till induction of anesthesia. The onset of sedation was documented when reaching MOAA/S of 5. Easiness of venipuncture and the degree of anxiety during parental separation were recorded using 4-point scales (Venipuncture score and Parental Separation Anxiety Scale, respectively). Results The cannula insertion was tolerated in the three groups, but the percent of patients in group D showed better conditions for cannula insertion as scored in venipuncture score. Group D showed better sedation level in MOAA/S. The time taken to reach MOAA/S of 4 (venipuncture time) was less in group D. Conclusion The study showed that using intranasal midazolam, dexmedetomidine, and ketamine facilitates the cannula insertion at the preoperative period, and they are safe and easy methods for sedation. The three drugs provided a satisfactory child-parent separation. However, intranasal dexmedetomidine provides statistically significant better conditions facilitating cannula insertion.