Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial

Objective A prospective, double-blind, randomized controlled trial to compare the effect of preoperative midazolam or ketamine on the incidence of emergence agitation (EA) following sevoflurane anaesthesia in children. Methods Paediatric patients (2-6 years old) undergoing ophthalmic surgery were allocated to receive premedication with either 0.1mg/kg midazolam or 1mg/kg ketamine. Incidence of EA and postoperative pain scores were recorded at 10-min intervals in the postanaesthetic care unit (PACU). The use of EA rescue medications (fentanyl or midazolam) was recorded. Results The incidence of EA was significantly lower in the ketamine group (n=33) than the midazolam group (n=34) at 10 and 20min after transfer to PACU. There was no significant difference in overall incidence of EA. The frequency of midazolam use as rescue medication was significantly lower in the katamine group than in the midazolam group. Conclusion Premedication with ketamine is more effective than midazolam in preventing EA during the early emergence period after sevoflurane anaesthesia in children.