Fears of operation, injections, physicians and operation theatre environment where the children are separated from their parents prior to anesthesia produces traumatic experiences in the mind of the young children.
Patients and Methods: ninety children of both sex, ASA physical status I-II, aged 4–7 years, scheduled for tonsillectomy operations. randomly allocated to 1 of the 3 groups 30 patients each by using a random number table.
Group M (Midazolam): Patients were premedicated with a dose of 0.5 mg/kg of injectable midazolam mixed in sugar free apple juice.
Group K (Ketamine): Patients were premedicated with a dose of (5 mg/kg) mixed in sugar free apple juice in total solution of 0.5 ml/kg.
Group C (Clonidine): Patients were premedicated with a dose of (4 mcg/kg). The Clonidine was prepared by dissolving crushed tablets of Clonidine. Oral sedative premedication in the form of syrup will be given 45 min before induction of general anesthesia, in the presence of parent.on arrival to the OR assessment of sedation score, easy separation score and behavior at time of venipuncture after induction of anesthesia recovery was assessed as base line then postoperative every 5 min till baseline score regained, using "Vancouver sedative recovery scale for children”. The incidences of adverse effects were also recorded. Then Assessment of amnesia after 24 hours by a telephone recall questionnaire of the parents.
Results: Sedation score was statistically significant difference among the groups after sedation from before sedation with no statistically significant difference among the studied groups (P = 0.108). Ease of separation scores was statistically significant difference among the groups after sedation from before sedation and there were statistically significant difference between ketamine and clonidine groups (P = 0.036) after sedation. As regard behavior at time of venipuncture scale among the three groups shows that ketamine administration resulted in better behavior than midazolam administration (P = 0.008), and clonidine administration (P = 0.004).As regard recovery and discharge times from anesthesia it was most rapid for group M and slowest for group K. The variation in recovery time between both groups M and K and groups M and C were very highly significant.
Conclusion: Oral administrations of ketamine 5 mg /kg is a suitable alternative to oral midazolam and provide better sedation than oral midazolam or oral clonidine but it slow in recovery when used as a sedative premedication in children.