Perumal Deepa Kameswari, Adhimoolam Mangaiarkkarasi, Selvaraj Nitya, Lazarus Suneeth Pullikotil, Mohammed Meher Ali Raja
Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
Department of Anesthesia, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
J Res Pharm Pract. 2015 Apr-Jun;4(2):89-93. doi: 10.4103/2279-042X.155758.
Ketamine administration is known to induce hemodynamic pressor response and psychomimetic effects which could be attenuated by appropriate premedication. The present study was designed to evaluate the effect of midazolam on hemodynamic stability and postoperative emergence phenomenon following ketamine anesthesia.
This was a prospective observational study including 30 adult patients with American Society of Anesthesiologists physical grades I and II scheduled for elective short surgeries under ketamine anesthesia. Patients were premedicated with midazolam (0.02 mg/kg intravenously) before the ketamine induction (1 mg/kg intravenously). Demographic data and hemodynamic variables were observed during the perioperative period. Pain score by visual analog scale score and psychomimetic effects were recorded postoperatively.
The mean ± standard deviation of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were decreased postoperatively (85.3 ± 11.4, 120.7 ± 8.2, 79.2 ± 5.5, 13.5 ± 1.8, respectively) compared to intraoperative period (88.53 ± 14.1, 123.83 ± 13.8, 83 ± 9.1, 14.13 ± 2.0, respectively). There was statistically significant decrease in systolic (P = 0.03) and diastolic (P = 0.002) blood pressure, but not with heart rate and respiratory rate. Eighty percent of patients had no pain at ½ hour and 1 hour, while this increased to 90% at 2 hours postoperatively. Mild emergence delirium was noted in 13.3% and 16.7% at ½ hour and 1 hour, respectively, which decreased to 13.3% at 2 hours. Dreams were noticed in 20%, 27% and 10% of patients at ½ hour, 1 and 2 hours after surgery, respectively.
Midazolam premedication in ketamine anesthesia effectively attenuated the hemodynamic pressor response and postoperative emergence phenomenon. Hence, the combination of midazolam with ketamine can be safely used for short surgical painful procedures in adults.
已知氯胺酮给药会引起血流动力学升压反应和拟精神病效应，适当的术前用药可减轻这些反应。本研究旨在评估咪达唑仑对氯胺酮麻醉后血流动力学稳定性和术后苏醒现象的影响。
这是一项前瞻性观察性研究，纳入30例美国麻醉医师协会身体状况分级为I级和II级、计划在氯胺酮麻醉下进行择期短期手术的成年患者。患者在氯胺酮诱导（静脉注射1mg/kg）前用咪达唑仑（静脉注射0.02mg/kg）进行术前用药。在围手术期观察人口统计学数据和血流动力学变量。术后记录视觉模拟量表评分的疼痛评分和拟精神病效应。
与术中相比（分别为88.53±14.1、123.83±13.8、83±9.1、14.13±2.0），术后心率、收缩压、舒张压和呼吸频率的平均值±标准差均降低（分别为85.3±11.4、120.7±8.2、79.2±5.5、13.5±1.8）。收缩压（P = 0.03）和舒张压（P = 0.002）有统计学意义的下降，但心率和呼吸频率没有。80%的患者在术后半小时和1小时无疼痛，而术后2小时这一比例增至90%。分别有13.3%和16.7%的患者在术后半小时和1小时出现轻度苏醒谵妄，术后2小时降至13.3%。术后半小时、1小时和2小时分别有20%、27%和10%的患者出现梦境。
氯胺酮麻醉中使用咪达唑仑进行术前用药可有效减轻血流动力学升压反应和术后苏醒现象。因此，咪达唑仑与氯胺酮联合应用可安全用于成人短期手术疼痛操作。
