1. 2020;23;E195-E202Analgo-Sedative Effects of Oral or Nebulized Ketamine in Preschoolers Undergoing Elective Surgery: A Comparative, Randomized, Double-Blind Study
   Randomized Trial
   Alshaimaa Abdel Fattah Kamel, MD, and Olfat Abdelmoniem Ibrahem Amin, MD.

BACKGROUND: Premedication in children with ketamine is useful to produce mild sedation, decrease anxiety, help the child separation from parents, and provide postoperative pain relief with no or little adverse effects.

OBJECTIVES: The aims of this study were to compare the level of sedation, parental separation, successful venous cannulation, and postoperative analgesia of oral or nebulized ketamine in preschoolers undergoing elective surgery.

STUDY DESIGN: A prospective, comparative, double-blind, randomized study.

SETTING: Zagazig University Hospitals.

METHODS: In the preparation room, 30 minutes before induction of anesthesia, 62 children were randomly divided into 2 groups: group O (n = 31) received oral ketamine 10 mg/kg in 2 mL apple juice, and group N (n = 31) received nebulized ketamine 3 mg/kg plus 2 mL isotonic saline solution by a standard hospital jet nebulizer via a mouth mask with a continuous 6 L/min flow of 100% oxygen.

RESULTS: At 10 minutes after premedication, sedation score was 3 in group O (34.4%) compared with group N (0%), and at 20 minutes in group O (93.5%) compared with group N (9.6%) (P < 0.001 ). However, at 30 minutes, 51.6% of group O showed a sedation score of 1 versus 0% of group N (P < 0.001 ). There were 70.9% of group O versus 6.4% of group N who showed an Emotional State Score of 1 (P < 0.0001), and 29.03% of group O versus 19.3% of group N who showed an Emotional State Score of 2 (P = 0.37), with statistically nonsignificant adverse effects in both groups. Low mean modified Children’s Hospital of Eastern Ontario Pain Scale score in group O compared with group N at 30, 60, 90 minutes (P < 0.0001).

LIMITATIONS: In this study, although the dose of nebulized ketamine was 3 mg/kg, which was more than the optimum dose investigated in previous studies, it was not adequate, so we recommend conducting more studies investigating higher doses.

CONCLUSIONS: Oral ketamine 10 mg/kg as premedication 30 minutes before induction of anesthesia is more effective than 3 mg/kg nebulized ketamine in producing more sedation, satisfactory separation from parents, successful venous cannulation, and effective postoperative analgesia, as it is more tolerable and accepted by preschoolers undergoing elective surgery.

KEY WORDS: Nebulized ketamine, oral ketamine, preschooler, elective surgery