Comparison of popsicles of oral midazolam, ondansetron, Ketamine and Atropine (MOKA) vs midazolam, Ondansetron and Atropine (MOA) vs Ketamine, Ondansetron and Atropine (KOA) as oral premedication for elective pediatric surgeries

Introduction: Premedication is widely used in pediatric anesthesia for sedation and anxiolysis. The fear of surgery and anxiety will be present in children and their parents. An ideal premedication should relieve anxiety, facilitate parenteral separation, acceptance of IV cannula and face mask. Its Incidence are higher in pre-school children. Most anesthesiologists use either presence of parent or sedative premedication during induction. Separation from parents and induction of anesthesia are the vital stress factors for children in the perioperative period. A good premedication in pediatric age group should be easy to use, should have rapid onset and short duration of action with less side effects.

**Aim:**To investigate whether combination of midazolam and ketamine in reduced dose as popsicles has the advantages of improved sedation with faster recovery and fewer adverse effects compared to single agents.

Hypothesis: Combining midazolam and ketamine in reduced dose as ice cubes will provide better sedation and parenteral separation in pediatric cases when compared to giving separately in regular dose.