the primary objective of this study is to investigate the sedative, and analgesic effects of oral, or nebulized ketamine as premedication drugs, and providing postoperative analgesia for the preschoolers and decrease their need for systemic analgesia.The secondary objective is to compare each sedation technique after oral, or nebulized ketamine for safety ,and procedural outcomes.
Preoperative communication, premedication interventions, and being accompanied by parents are useful methods in decreasing preoperative separation anxiety , postoperative psychological trauma, and ensuring smooth induction for preschoolers undergoing elective surgery. Procedural sedation, and analgesia was defined by O'Donnell as a drug induced state of decreasing awareness, pain, and memory that allowing patient continue his ,or her own protective reflexes, and moving purposefully( O' Donnell etal, 2003). Ketamine is an anesthetic drug having sedative, and analgesic properties with different routes of administration in children (IV, intramuscular, subcutaneous, oral, rectal, sublingual, intranasal, and nebulized) . Ketamine produces its analgesic properties in acut pain management from reversible antagonizing the N-methyl-D-aspartate (NMDA)receptors , reducing levels of many proinflammatory mediators in the acute phase, and acting on other non-NMDA pathways that playing important roles in pain, and mood regulation, like its effect on µ-opioid receptors, nicotinic, muscarinic cholinergic, ɣ-aminobutyric acid receptors, activation of high -affinity D2 dopamine receptors, and L-type voltage-gated calcium channels. The oral route is the most popular than other routes ,as it's safe, efficient, acceptable, and familiar for pediatric patients.. Oral ketamine often requires higher, and frequent doses as it's bioavailability is lower (17-24%) compared to IV (100%),Intramuscular (93%), sublingual/transbuccal(30%), intranasal(25-50%),and inhaler (70%) due to extensive first pass metabolism in liver, and intestine. Ketamine inhalation is safe, rapid absorption, and affordable route of administration.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
62
evaluate sedative, and analgesic effects of oral or nebulized ketamine
Zagazig University Hospitsals
Zagazig, Egypt
evaluate sedative effects of oral, or nebulized ketamine in preschoolers undergoing elective surgery
• To assess onset time of sedation by sedation scale (SS-5) score. The sedation scale: 1. Rarely awake, needs shaking, or shouting to wake up. 2. Asleep, eyes closed, wake up when called softly,or lightly touched. 3. Sleepy, but eyes open spontaneously. 4. Awake. 5. Agitated.
Time frame: 30 minutes.
compare each sedation technique for the time of separation state.
The separation state will be assessed and designated as satisfactory separation if the Emotional State Scale (ESS-4) score will be no more than two points. The Emotional State Scale (ESS-4): 1. Calm. 2. Apprehensive, not smiling, tentative behavior, withdrawn. 3. Crying. 4. Thrashing, crying with movements of the arms, and legs, resisting.
Time frame: at 30 minutes after drug intake
compare the sedation technique for successful venous cannulation.
Successful venous cannulation is defined as an Emotional State Scale (ESS-4≤ 2). The Emotional State Scale (ESS-4): 1. Calm. 2. Apprehensive, not smiling, tentative behavior, withdrawn. 3. Crying. 4. Thrashing, crying with movements of the arms, and legs, resisting.
Time frame: at time of attempted cannulation, regardless of whether the vein is actually cannulated on the first attempt.
to compare the intensity of pain postoperative.
the intensity of pain will be assessed using modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Score 1 2 3 Cry No cry Crying, moaning Scream Facial Smiling Composed Grimace Verbal Positive None, or other complaints Pain complaint Torso Neutral Shifting, tense, upright Restrained Leg Neutral kicks, squirm, drawn up Restrained Touch No touching Reach, touch, grab Restrained CHEOPS pain score=SUM(0)(points for all 6 parameters). Interpretation : minimum score:6, maximum score:18.
Time frame: immediately after recovery, and every half hour for four hours postoperative
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