Effectiveness of premedication at the time of separation from parent and mask induction in paediatric patients coming for congenital heart disease surgery.

OBJECTIVE To compare the effectiveness of oral midazolam and chloral hydrate on anxiety and sedation at various stages of pre-operative period in congenital heart surgery patients. STUDY DESIGN Cross-sectional comparative study. PLACE AND DURATION OF STUDY Operating rooms of The Aga Khan University Hospital, Karachi, from October 2009 to December 2010. METHODOLOGY Sixty-six patients between the ages of 6 months and 6 years received either chloral hydrate (Group C) or midazolam (Group M) pre-operatively. All congenital heart disease patients coming for cardiac surgeries were included while cases of emergency surgery and those patients in whom premedication was not given were excluded. Effect of premedication observed and documented by Anaesthesia Consultant. Documentation included demographics, level of anxiety and sedation at the time of separation from parent and at the time of mask application. RESULTS Forty study subjects were male (61%) and 26 were females (39%). Eleven patients received oral midazolam while 55 received oral chloral hydrate. Sixteen patients were tearful and anxious (24%) while rests were calm and asleep. Thirty patients in group C (60%) were well sedated at the time of separation. Mask induction was satisfactory in 76% of chloral hydrate patients. Increase dose was suggested in 23 patients by anaesthetizing physician. Out of these 6 belonged to group M (54.5%) while 17 to low dose chloral hydrate group (30.9%) [< 40 mg/kg]. CONCLUSION Chloral hydrate provides comparable anxiolysis but superior sedation and mask acceptance scores when compared with midazolam. Higher doses of chloral hydrate (50 mg/kg) were required to keep these patients calm and peaceful at the time of mask application for inhalation induction.