Premedication in paediatric patients undergoing MRI: comparative study of intramuscular ketamine 3mg/kg with dexmedetomidine 1.5mcg/kg versus ketamine 3mg/kg with midazolam 0.05mg/kg

A  total of sixty patients aged between one to ten years undergoing elective MRI will be enrolled in the study and will be randomly divided in to two groups DK-dexmedetomidine ketamine and group MK-midazolam ketamine.DK groups will receive intramuscular injection of ketamine 3mg/kg with dexmedetomidine 1.5mcg/kg and group MK will receive intramuscular injection of ketamine 3 mg/kg with midazolam 0.05mg/kg. Injection glycopyrrolate at dose of 5mcg/kg will be given to both groups. Baseline vitals will be recorded. Following this, intramuscular injection at anterolateral aspect of thigh will be given. After ten minutes of injection, attempt will be made to separate the child from the parent and ease of parent separation will be assessed according to scoring scale. Once child is separated, an attempt for securing an intravenous cannula will be done and the ease of securing the cannula will also be given scores according to the scale. After this, child will be taken into the mri suite. pulse rate, oxygen saturation, respiratory rate and blood pressure will be documented every five minutes till the first thirty minutes of procedure followed by documentation every fifteen mins till two hours. If child awakens during the procedure intravenous propofol at a dose of 0.5mg/kg will be given and the total dose will be recorded. Once the procedure is completed child will be transferred to the recovery room and will be observed till the child meets the discharge criteria. Time taken to fulfill the criteria will also be recorded.

Parent separation anxiety scale

• Patient unafraid, cooperative, asleep=1
• Slight fear or crying, cooperative with reassurance=2
• Moderate fear, crying, not quiet with reassurance=3
• Crying, need for restraint=4

Ease of IV cannulation

• No reaction=1
• Minor resistance=2
• Fights without success=3
• Fights with success=4

Discharge criteria

• Cardiovascular function and airway patency are satisfactory and stable
• The patient is easily arousable, and protective reflexes are intact
• The patient can talk/phonate (if age appropriate)
• The patient can sit up unaided (if age appropriate)
• For a very young or handicapped child incapable of the usually expected responses, the pre sedation level of responsiveness or a level as close as possible to the normal level for the child should be achieved
• The state of hydration is adequate