Discussion
anxiety
DISEASE
We determined that the preoperative EDMidazolam, dexmedetomidine, and Ketamine are commonly used for preoperative sedation in children. An early in vitro animal experiment suggested that ketamine may be able to exert a potent diastolic effect on the intima of the pulmonary artery, thus reducing pulmonary circulation resistance [Unlike the previously reported studies, our study is one of the few studies that confirmed the EDEarlier studies on preoperative medication in children with CHD suggested that both intranasal administrations of 2 mg/kg ketamine and oral administration of 5 mg/kg ketamine were safe and effective for preoperative medication in children with TOF [Our study found that the EDMost researchers also define “cooperation without anxiety” as the criterion of successful sedation without considering the presence or absence of deep sleeping. Intranasal administration of 6 mg/kg ketamine created an appropriate depth of sedation in approximately 92% of cases, with a mean onset time of 5.79 ± 1.42 min. As the dose of ketamine is relatively large, some researchers recommended using the high-concentration of 100 mg/ml [Although many studies believe that most children cannot comply with intranasal drug administration, only 1 child in our study had obvious non-compliance and resistance to intranasal premedication and needed physical restraint with the help of the parents for drug administration. The volume of drug administration in this study was less than 0.15 ml, and no child exhibited significant symptoms of pharmacochemical stimulation, suggesting that esketamine has minimal intranasal stimulation and the intranasal route is appropriate for drug administration. The intranasal stimulation symptoms observed in 36.1% of patients administered midazolam differed in several ways from those observed in this study [This study has several limitations. Firstly, we failed to make precise discriminations of the pediatric patient personality characteristics before the initiation of the study, knowing that different personalities may affect the sedative outcome on the day of surgery. In addition, we could not stratify the disease type and age because of the relatively small number of included patients. Therefore, we could not include patients of the same age group and the same kind of CHD for analysis. Thirdly, we did not use the atomizer. While atomizers offer a convenient means of administering nasal medication, their use is limited by the financial constraints faced by many caregivers who may require assistance in procuring the relatively expensive nasal atomizers. Finally, we did not further observe the sedative or analgesic effects after the patients entered the operating room.