Table 1.
Characteristics of the studies.
| Study | Source | Country | Language | n MIKE1 | n MDZ2 | Age range | Type of surgery | MIKE Doses | MDZ dose | Vehicle | Volume | Timing | Reported outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Astuto 2002 | Article | Italy | English | MK1.ß=.ß40; MK2.ß=.ß42 | 38 | 2...6 years | Urologic | Group MK1: M 0.3.ß+.ßK 1.ßmg.kg-1 and Group MK2: M 0.3.ß+.ßK 2.ßmg.kg-1 | 0.5.ßmg.kg-1 | Glucose syrup | 1...2 teaspoons | 30.ßmin before induction | sedation, anxiolysis, parental separation, face mask acceptance, adverse events: PONV, headache, diplopia, hallucinations |
| Darlong 2004 | Article | India | English | 24 | 24 | 1...9 years | Eye surgery | M 0.25.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | 50% dextrose | Up to 0.3.ßmL.kg-1 | 30.ßmin before induction | sedation, parental separation, face mask acceptance, adverse events: PONV, salivation, irrelevant talking, breath holding |
| Darlong 2011 | Article | India | English | MKL.ß=.ß29; MKH.ß=.ß29 | 29 | 1...10 years | Eye surgery | Group MKL M 0.25.ß+.ßK 3.ßmg.kg-1 and Group MKH: M 0.5.ß+.ßK 6.ßmg.kg-1 | 0.5.ßmg.kg-1 | Honey | Up to 0.5.ßmL.kg-1 | 30.ßmin before induction | sedation, parental separation, face mask acceptance, adverse events: PONV, salivation, irrelevant talking breath holding |
| Foroutan 2007 | Article | Iran | English | 50 | 59 | 2...8 years | Cardiac | M 0.25.ß+.ßK 3.ßmg.kg-1.ß+.ßatropine 0.02.ßmg.kg-1 | 0.5.ßmg.kg-1 | Apple juice | Up to 5...8.ßmL | 45.ßmin before induction | parental separation, behavior at venepuncture, face mask acceptance |
| Funk 2000 | Article | Germany | English | 39 | 38 | 2...10 years | Elective surgery more than 30.ßminute-expected duration | M 0.5.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | Strawberry-flavored glucose syrup | Up to 12.5.ßmL | 30.ßmin before induction | Sedation, anxiolysis, parental separation, behavior at venepuncture; PONV, vertigo,psychodelic symptoms, salivation |
| Ghai 2005 | Article | India | English | 49 | 48 | 10 months...6 years | Elective surgery | M 0.25.ß+.ßK 2,5.ßmg.kg-1 | 0.5.ßmg.kg-1 | Honey | Not reported | 20.ßmin prior to induction | sedation, anxiolysis, parental separation, face mask acceptance, adverse events: PONV |
| Hasani 2000 | Article | Iran | Persian | 50 | 50 | Elective surgery | M 0.25.ß+.ßK 2,5.ßmg.kg-1 | 0.5.ßmg.kg-1 | Not reported | Not reported | 30.ßmin before induction | sedation, parental separation, face mask acceptance. | |
| Jain 2010 | Article | India | English | 31 | 29 | 1...5 years | CT imaging | M 0.25.ß+.ßK 1.ßmg.kg-1 | 0.5.ßmg.kg-1 | Honey | 5.ßmL | 20...30.ßmin before venepunction | behavior at venepuncture, sedation, parental satisfaction |
| Kulikov 2010 | Article | Russia | Russian | 80 | 20 | Elective neurosurgery | M 0.5.ß+.ßK 3.ßmg.kg-1 | 0.75.ßmg.kg-1 | Honey or thick syrup (e.g.hawthorn) | 10.ßm.ßL | 40 min before induction | sedation, behavior at venepuncture | |
| Kumar 2009 | Article | India | English | 20 | 20 | 3...10 years | Elective surgery | M 0.3.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | Apple juice | Up to 0.5.ßmL.kg-1 | 30.ßmin before induction | Sedation, anxiolysis, parental separation, behavior at venepuncture; facial mask acceptance PONV |
| Lin 1993 | ASA Meeting Abstract | USA | English | 15 | 15 | under 8 years | Ambulatory surgeries | M 0.5.ß+.ßK 3.ßmg.kg-1 | 0.75.ßmg.kg-1 | Apple juice | 3.ßmL | 20...30.ßmin before induction | Sedation, parental separation, face mask acceptance, behavior at venepuncture adverse events: salivation, nistagmus. |
| Magar 2016 | Article | India | English | 30 | 30 | 3...10 years | Surgeries under general anesthesia | M 0.5.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | Midazolam syrup (2.ßmg.mL-1) / parenteral preparation of ketamine dissolved in 5% dextrose | According to the total dose of midazolam for each group. | 30.ßmin before surgery | Sedation, anxiolysis, parental separation, behavior at venepuncture; Face mask acceptance hallucinations, salivation, excessive sedation |
| Majidinejad 2015 | Article | Iran | English | 33 | 33 | 6 months...6 years | Brain CT | M 0.2.ß+.ßK 5.ßmg.kg-1 | 0.5.ßmg.kg-1 | Sugar syrup | 5.ßmL | 40.ßmin before the scheduled procedure | sedation. PONV |
| Mithun 2018 | Article | India | English | 50 | 50 | 2...10 years | Elective surgeries between 20.ßminutes to 2 hours | M 0.5.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | Orange syrup | 0.5.ßmL.kg-1 up to a maximum of 10.ßm.ßL | 30.ßmin before induction | Sedation, anxiolysis, parental separation, PONV, nystagmus, salivation, tachycardia, bradycardia, exitement, involuntary movements, respiratory depression |
| Rabie 2005 | Article | Egypt | English | 30 | 30 | 3...8 years | Tonsillectomy with or without adenoidectomy | M 0.25.ß+.ßK 4.ßmg.kg-1 | 0.5.ßmg.kg-1 | Cherry or orange syrup | 5.ßmL | 20.ßmin prior to induction | sedation, parental separation, face mask acceptance, adverse events: PONV |
| Ramakrishna 2018 | Article | India | English | 50 | 50 | 2...10 years | Surgeries lasting more than 30.ßminutes | M 0.5.ß+.ßK 3.ßmg.kg-1 + atropine 0.02.ßmg.kg-1 | 0.5.ßmg.kg-1 + atropine 0.02.ßmg.kg-1 | Honey | Up to 0,5.ßmL.kg-1 | 30.ßmin before induction | Sedation, anxiolysis, parental separation, behavior at venepuncture. |
| Sajedi 2014 | Article | Iran | Persian | 68 | 68 | 6 months...6 years | Outpatient eye surgery | M 0.25.ß+.ßK 2.5.ßmg.kg-1 | 0.5.ßmg.kg-1 | Strawberry-flavored juice | Up to 0,5.ßmL.kg-1 | 30.ßmin before induction | Sedation, anxiolysis, parental separation, behavior at venepuncture. PONV |
| Sathyan 2006 | Doctoral thesis | India | English | 25 | 25 | 1...12 years | Surgeries lasting at least 30.ßminutes | Group A - M 0.3.ß+.ßK 1.ßmg.kg-1; Group B- M 0.3.ß+.ßK 2.ßmg.kg-1 | 0.5.ßmg.kg-1 | Solution mixed with sugar crystals.ß+.ß2-3.ßg of sugar crystal to chew | Not reported | 30.ßmin before induction | Sedation, parental separation, behavior at venepuncture, face mask acceptance. Hiccoughs, delayed recovery |
| Walia 2017 | Article | India | English | 30 | 30 | 1...8 years | Elective surgeries lasting less than 3 hours | M 0.25.ß+.ßK 3.ßmg.kg-1 | 0.5.ßmg.kg-1 | Acetaminophen syrup (5.ßmL.ß=.ß120.ßmg) | Up to 0,4.ßmL.kg-1 | 30.ßmin before induction | Sedation, parental separation, face mask acceptance, emergence score. Hiccoughs, delayed recovery |
| Warner 1995 | Article | USA | English | 20 | 20 | 1.5...7 years | Minor outpatient surgeries | M 0.4.ß+.ßK 4.ßmg.kg-1 + atropine 0.02.ßmg.kg-1 | 0.5.ßmg.kg-1 + atropine 0.02.ßmg.kg-1 | Cherry syrup | 1 - 2 teaspoons | 20...30.ßmin before surgery | Sedation, anxiolysis, parental separation, facial mask acceptance |
1
MIKE, Group that received the combination of midazolam and ketamine.
2
MDZ, Group that received the combination of midazolam and ketamine; M, Midazolam; K, ketamine.