Original Article

Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

  • Rahşan Karayazılı
  • Işıl Özkoçak
  • Hilal Ayoğlu
  • Serhan Yurtlu
  • Dilek Okyay
  • Volkan Hancı

Received Date: 28.09.2010 Accepted Date: 01.11.2010 Med Bull Haseki 2010;48(4):146-152


The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain.


Sixty pediatric patients (aged 2-12 years) with American Society of Anesthesiology (ASA) classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP), heart rates (HR), Ramsey sedation scores (Rss) and sedation agitation scores (Sas) were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2 . Recovery times, Alderete scores and facial pain scores (FPS) were recorded.


There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05). There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium.


Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents.

Keywords: Pediatrics, Postoperative, agitation, premedication, tramadol, ketamine, midazolame

Full Text (Turkish)