Bameshki Seyed Alireza, Salari Mohammad Reza, Bakhshaee Mahdi, Razavi Majid
Cardiac Anesthesia Research Center, Imam-Reza Hospital, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.
Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Otorhinolaryngol. 2015 Nov;27(83):429-34.
Tonsillectomy is the one of the most common types of surgery in children, and is often accompanied by post-operative pain and discomfort. Methods of pain control such as use of non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, and local anesthetics have been used, but each have their own particular side effects. In this study we investigated the effect of ketamine on post-operative sedation and pain relief.
A total of 50 children aged between 5 and 12 years who were candidates for tonsillectomy were divided into two groups. The study group received ketamine-midazolam (ketamine 1 mg/kg, midazolam 0.1 mg/kg) and the control group received midazolam (0.1 mg/kg) in the pre-operative period. The same methods of anesthesia induction and maintenance were used in all patients. Pain score was assessed using the Wong-Baker Faces Pain Rating scale and sedation was evaluated using the Riker Sedation-Agitation scale at the time of extubation as well as 5, 10, 15, and 30 minutes and 1, 2, and 6 hours after surgery.
The two groups were similar in terms of age, weight, gender and duration of surgery. Pain after 15 and 30 minutes and agitation after 10 and 15 minutes following extubation were lower in the study group (ketamine-midazolam). Mean consumption and time of first request for analgesia after surgery as well as incidence of post-operative vomiting were similar in the two groups.
Adding ketamine to midazolam in pre-operative of tonsillectomy reduces agitation and post-operative pain in the first 30 minutes after surgery.
扁桃体切除术是儿童最常见的手术类型之一，术后常伴有疼痛和不适。已采用多种疼痛控制方法，如使用非甾体抗炎药（NSAIDs）、麻醉药和局部麻醉剂，但每种方法都有其特定的副作用。在本研究中，我们调查了氯胺酮对术后镇静和疼痛缓解的影响。
共有50名年龄在5至12岁之间、拟行扁桃体切除术的儿童被分为两组。研究组在术前接受氯胺酮-咪达唑仑（氯胺酮1mg/kg，咪达唑仑0.1mg/kg），对照组接受咪达唑仑（0.1mg/kg）。所有患者均采用相同的麻醉诱导和维持方法。在拔管时以及术后5、10、15和30分钟以及1、2和6小时，使用面部表情疼痛评分量表评估疼痛评分，并使用里克尔镇静-躁动量表评估镇静情况。
两组在年龄、体重、性别和手术持续时间方面相似。研究组（氯胺酮-咪达唑仑）在拔管后15和30分钟时的疼痛以及10和15分钟时的躁动较轻。两组术后首次要求镇痛的平均用药量和时间以及术后呕吐发生率相似。
在扁桃体切除术术前将氯胺酮添加到咪达唑仑中可减轻术后前30分钟的躁动和疼痛。
