Paediatric Anaesthesia Pre-Medication

Kids are very special for me when it come to anything and anaesthesia is no different. And it is no joy to see any of them cry. I have seen many that anaesthesiologists are afraid of giving any premedication to kids before the i.v. is established. And it is a horrible thing to watch an i.v. being placed with the baby shouting and crying.

Two years back I came across someone who taught me to give safe premedication to kids. She is a brilliant teacher and a confident anaesthesiologist. 

Since then I have been using this technique. It is simple , yet effective. The baby is kept with his parents. A single intramuscular injection of ketamine 5mg/Kg body weight + Midazolam 0.1mg/Kg is given. This makes the baby to go to sleep in 5 to 10 minutes  in the parent’s arms. Oh is it a beautiful sight and a wonderful experience to carry a peaceful baby into the O.R. 

Placing an i.v. access is easy, with the baby sleeping comfortably. Anaesthesia is then administered with either i.v. propofol or inhalation technique.  I have used both and found that propofol causes pain on injection in some kids especially when i.v access is in a small caliber vien. The inhalational induction with halothane is a bit comfortable but is relatively more time consuming. 

My experience might not be a very big thing for people who have all the advanced anaesthesia drugs and equipment. But for me it is a delight. It gives a sense of relief from the pain of watching beautiful babies shouting and crying while being taken into the O.R. In addition ,it spares the parents from the trauma of sending their crying baby for surgery.