Comparative Evaluation of Oral Ketamine-Dexmedetomidine Versus Oral Ketamine-Midazolam as Premedication in Pediatric Patients Undergoing Elective Surgery Under Anaesthesia
: Background: Preoperative anxiety is a significant challenge in pediatric anaesthesia, necessitating effective premedication strategies. Oral drug combinations offer a non-invasive and child-friendly approach to achieving adequate sedation and anxiolysis. This study evaluates two commonly employed oral premedication regimens-ketamine combined with dexmedetomidine (KD) and ketamine combined with midazolam (KM) — in children aged 2 – 10 years scheduled for elective procedures. Methods: A prospective observational study was conducted at a tertiary care hospital over 14 months (March 2024 – May 2025). Sixty pediatric patients (ASA I – III, aged 2 – 10 years) were allocated into two groups of 30 each. Group KM received oral ketamine 3 mg/kg + midazolam 0.3 mg/kg, and Group KD received oral ketamine 3 mg/kg + dexmedetomidine 3 mcg/kg, each diluted in mango juice and administered 50 minutes before surgery. Sedation was assessed using the Modified Observer's Assessment of Alertness/Sedation (MOAAS) scale, parental separation anxiety score, mask acceptance scale, and hemodynamic parameters. Results: At the 50-minute time point, Group KD showed significantly deeper sedation (MOAAS: 2.1 ± 0.64) compared to Group KM (2.6 ± 0.60; p < 0.05). Parental separation was rated excellent in 90% of KD patients versus 56.7% in KM (p < 0.001). Mask acceptance was superior in KD (83.3% excellent) compared to KM (46.7% excellent; p = 0.006). Hemodynamic parameters remained clinically stable in both groups with no significant intergroup differences. No adverse events were recorded in either group. Conclusion: Both premedication regimens demonstrated acceptable sedative profiles; however, the ketamine-dexmedetomidine combination provided superior sedation depth, smoother parental separation, and better mask acceptance with a comparable safety profile. These findings support ketamine-dexmedetomidine as a preferred oral premedication option in pediatric patients undergoing elective surgery.