Midazolam versus ketamine in the management of emergence agitation in children undergoing lower abdominal and limb surgeries

Emergence agitation (EA) is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years. In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam (28) or 0.5 mg/kg ketamine (29) by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation (agitation score), severity of pain (pain score), anesthesia, recovery and extubation durations were recorded postoperatively. The prevalence of agitation in midazolam (21.4%) was lower than ketamine group (34.5%; P<0.05). In addition, the duration of agitation in ketamine group (21±16.67 min) was significantly higher than midazolam group (6.83±6.55 min), (P<0.05). However, no significant differences were seen in agitation score, pain score, anesthesia, recovery or extubation durations in the two groups (P>0.05). The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children.