We compared the efficacy of intranasal
midazolam,
ketamine and their mixture as
premedication in children with
tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal
ketamine (10 mg/Kg), Group-B received intranasal
midazolam (0.2 mg/Kg), while Group-C received a mixture of
ketamine (7.5 mg/Kg) and
midazolam (0.1 mg/Kg) intranasally. After 30 minutes of
premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in
midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous
catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sedation scores in group A and C were excellent (3.75 +/- 0.44 and 3.80 +/- 0.41 respectively). Separation from parent was excellent in group A (
ketamine) and group C (mixture) (group A- 3.90 +/- 0.28 and group C- 3.83 +/- 0.35 respectively). Children of both these groups allowed easy placement of intravenous
cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal
midazolam and mixture containing
ketamine and
midazolam (group B and C respectively), while it remained high in children who received
ketamine. We conclude that intranasal
ketamine is better than intranasal
midazolam. The combination of two is better than
midazolam alone but provides no benefit as compared with
ketamine alone.