Abstract
As the ideal sedative does not exist for all situations, we examined the effect of a midazolam-ketamine sedoanalgesic admixture in human volunteers. Ten ASA physical status I volunteers were administered loading doses of 0.07 mg/kg of midazolam followed by 0.7 mg/kg of ketamine. The same amount of midazolam and ketamine was then infused constantly over 1 hour via a 60 drops (gtts)/mL i.v. infusion set. Blood samples were analyzed for plasma catecholamine levels. Respiration rate and oxygen saturation did not alter significantly from baseline levels. Heart rate and systolic blood pressure remained stable with an increase of 15% in heart rate and 6% in systolic blood pressure only at 10 minutes following the bolus loading. Diastolic blood pressure did not alter significantly from baseline levels (P < .05). Plasma catecholamines levels remained stable except for an increase in epinephrine (38%) and norepinephrine (19%) 10 minutes following the bolus injections. Plasma dopamine levels remained unchanged. There were no cases of unpleasant dreaming, dysphoria, or emergence-type reactions. This combined nonnarcotic sedoanalgesic technique maintains spontaneous ventilation and stable cardiorespiratory parameters and may be considered as an alternative to traditional conscious sedation or general anesthesia.
Full text
PDF



Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bailie R., Craig G., Restall J. Total intravenous anaesthesia for laparoscopy. Anaesthesia. 1989 Jan;44(1):60–63. doi: 10.1111/j.1365-2044.1989.tb11102.x. [DOI] [PubMed] [Google Scholar]
- Bergman S. A. Ketamine: review of its pharmacology and its use in pediatric anesthesia. Anesth Prog. 1999 Winter;46(1):10–20. [PMC free article] [PubMed] [Google Scholar]
- Deng X. M., Xiao W. J., Luo M. P., Tang G. Z., Xu K. L. The use of midazolam and small-dose ketamine for sedation and analgesia during local anesthesia. Anesth Analg. 2001 Nov;93(5):1174–1177. doi: 10.1097/00000539-200111000-00023. [DOI] [PubMed] [Google Scholar]
- Giovannitti J. A., Jr Dental anesthesia and pediatric dentistry. Anesth Prog. 1995;42(3-4):95–99. [PMC free article] [PubMed] [Google Scholar]
- Gruber R. P., Morley B. Ketamine-assisted intravenous sedation with midazolam: benefits and potential problems. Plast Reconstr Surg. 1999 Nov;104(6):1823–1827. [PubMed] [Google Scholar]
- Haas D. A., Harper D. G. Ketamine: a review of its pharmacologic properties and use in ambulatory anesthesia. Anesth Prog. 1992;39(3):61–68. [PMC free article] [PubMed] [Google Scholar]
- Hong W., Short T. G., Hui T. W. Hypnotic and anesthetic interactions between ketamine and midazolam in female patients. Anesthesiology. 1993 Dec;79(6):1227–1232. doi: 10.1097/00000542-199312000-00013. [DOI] [PubMed] [Google Scholar]
- Korttila K., Levänen J. Untoward effects of ketamine combined with diazepam for supplementing conduction anaesthesia in young and middle-aged adults. Acta Anaesthesiol Scand. 1978;22(6):640–648. doi: 10.1111/j.1399-6576.1978.tb01348.x. [DOI] [PubMed] [Google Scholar]
- Langrehr D., Agoston S., Erdmann W., Newton D. Pharmacodynamics and reversal of benzodiazepine-ketamine ataranalgesia. S Afr Med J. 1981 Mar 18;59(12):425–428. [PubMed] [Google Scholar]
- Lechner M. D., Kreuscher H. Chemische Kompatibilität von Ketamin und Midazolam in Infusionslösungen. Anaesthesist. 1990 Jan;39(1):62–65. [PubMed] [Google Scholar]
- Marx C. M., Stein J., Tyler M. K., Nieder M. L., Shurin S. B., Blumer J. L. Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. J Clin Oncol. 1997 Jan;15(1):94–102. doi: 10.1200/JCO.1997.15.1.94. [DOI] [PubMed] [Google Scholar]
- Oda A., Iida H., Dohi S. Patient anxiety scores after low-dose ketamine or fentanyl for epidural catheter placement. Can J Anaesth. 2000 Sep;47(9):910–913. doi: 10.1007/BF03019675. [DOI] [PubMed] [Google Scholar]
- Reboso Morales J. A., González Miranda F. Ketamina. Rev Esp Anestesiol Reanim. 1999 Mar;46(3):111–122. [PubMed] [Google Scholar]
- Restall J., Tully A. M., Ward P. J., Kidd A. G. Total intravenous anaesthesia for military surgery. A technique using ketamine, midazolam and vecuronium. Anaesthesia. 1988 Jan;43(1):46–49. doi: 10.1111/j.1365-2044.1988.tb05424.x. [DOI] [PubMed] [Google Scholar]
- Sherwin T. S., Green S. M., Khan A., Chapman D. S., Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000 Mar;35(3):229–238. doi: 10.1016/s0196-0644(00)70073-4. [DOI] [PubMed] [Google Scholar]
- Suzuki M., Tsueda K., Lansing P. S., Tolan M. M., Fuhrman T. M., Sheppard R. A., Hurst H. E., Lippmann S. B. Midazolam attenuates ketamine-induced abnormal perception and thought process but not mood changes. Can J Anaesth. 2000 Sep;47(9):866–874. doi: 10.1007/BF03019666. [DOI] [PubMed] [Google Scholar]
- Thiel A., Zickmann B., Roth H., Hempelmann G. Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia. J Clin Monit. 1995 Mar;11(2):92–98. doi: 10.1007/BF01617730. [DOI] [PubMed] [Google Scholar]
- Tobias J. D. End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures. Pediatr Emerg Care. 1999 Jun;15(3):173–175. doi: 10.1097/00006565-199906000-00002. [DOI] [PubMed] [Google Scholar]
- White P. F. Comparative evaluation of intravenous agents for rapid sequence induction--thiopental, ketamine, and midazolam. Anesthesiology. 1982 Oct;57(4):279–284. doi: 10.1097/00000542-198210000-00005. [DOI] [PubMed] [Google Scholar]