Moka icecube for paediatric premedication
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This document describes a study on using "MOKA ice cubes" for oral premedication in pediatric patients undergoing anesthesia. MOKA ice cubes contain midazolam, ondansetron, ketamine, and atropine. 25 pediatric patients aged 2-15 years received MOKA ice cubes 1 hour before anesthesia. All patients were sedated and separated from parents without difficulty. No major side effects occurred. The combination of oral drugs provided effective premedication without distress for children or families.
Moka icecube for paediatric premedication
- 1. MOKA ICECUBES ( A Novel Combination of Oral Premedication in Paediatric Patients ) Dr. Tushar Chokshi M.D. Private Practicing Anaesthesiologist VADODARA
- 2. Background • Pre surgery anxiety in children may result in preoperative and postoperative complications • Anxiety associated with operative procedures is distressful for children and families • Preoperative anxiety displayed several ways * difficulty separating from parents * difficulty accepting anaesthesia mask * to access intravenous line
- 3. Aims & Objectives • To provide comprehensive and easily available preparation of premedication in paediatric patients undergoing anaesthesia • To study the effect of combining four common drugs Midazolam, Ondansetron given orally as ice cubes for premedication Ketamine Atropine
- 4. Materials & Methods • Permission of my surgical colleagues and explaining in details to the parents of paediatric patients • 25 paediatric patients aged from 2 to 15 years and ASA-1 selected • Surgical procedures were * Tonsillectomy * Circumcision * Congenital hernia repair * Cervical lymph node removal Investigations e.g. Hb, TC, DC, BT, CT, FBS and chest X-ray (sos)
- 5. Contd…. • Patients were given MOKA ice cubes according to age by trained OT staff one hour before anaesthesia and surgery • MOKA ice cubes are prepared with mixing all four drugs from IV ampoules 2 ml each, and putting that liquid in deep freeze to form ice • Dose was given as follows : 2 year ------ 1 ice cube 2-5 Year ---- 2 ice cubes 5-10 Year --- 3 ice cubes 10-15 Year --4 ice cubes One Icecube Contains Midazolam 2 ml ------ 2 mg Ondansetron 2 ml ---- 4 mg Ketamine 2 ml -------- 100 mg Atropine 2 ml ----------1 mg During one hour trained OT staffs were continuously monitoring the patient with pulse oximeter and any nausea or vomiting were noted & Parents were strictly instructed to allow sleeping their child after oral ice cube premedication
- 6. Oral Pharmacological Dose ( as per textbook) • Midazolam 0.2 mg /kg • Ondensetron 0.2 – 0.4 mg/kg • Ketamine 6 - 10 mg /kg • Atropine 0.1 -0.2 mg /kg
- 7. Results • After one hour all patients were sedated and separated from their parents without any difficulty • No major side effects or complications found during one hour after oral dose except complaint of giddiness and sleepy state mind • Not a single patient required intubation or airway insertion • During one hour clinically patients’ vitals were stable & SpO2 maintained very well between to 95 to 100 % without oxygen
- 8. Discussion • Preoperative period is a stressful event for the majority of paediatric patients undergoing surgery and anaesthesia • Pharmacological and behavioural interventions are used to treat preoperative anxiety in children and their parents • In order to alleviate physiological and psychological effects of preoperative anxiety in children, most anaesthesiologists use either presence of parents or sedative premedication, since separation from parents and induction of anaesthesia are considered the most stress inducing phases
- 9. Contd… • Anaesthesiologists who allow presence of parents during induction of anaesthesia and oral sedative premedication win the situation • All four drugs are given orally as an individual agent but none of them alone if given orally gives good sedation or favourable condition to separate paediatric patient from their parents • After combining all four drugs and given orally the absorption is from 16 to 25 % • side effects of each individual drug less in orally than given by other routes e.g. IV or IM, but sedative effect is good to control paediatric patient
- 10. Conclusion • MOKA ice cube is novel mixture of Midazolam, Ondansetron, Ketamine and Atropine • After oral premedication all paediatric patient are calm, cool, quiet, sleepy and separation from their parents are without any problem • We do not find any crying, rowdiness, injection fear or anxiety in both patients as well as in parents