Ketamine is an IV anesthetic that is often used for short surgical procedures. However, induction with ketamine can often cause agitation events. It is no fun for patients, nurses, and patients' families so as to make ketamine less acceptable, unless there are specific indications. Various drugs have been studied to reduce the incidence of agitation. Benzodiazepine is the most satisfactory drug as an adjunct in reducing the problem. Lorazepam, diazepam, flunitrazepam and ketamine has been studied as an adjunct. Unfortunately, flunitrazepam was found to cause disorders of mental activity and amnesia longer, give lorazepam onset and recovered more slowly realize that, and diazepam increased the incidence of nightmares.
Midazolam is a water soluble benzodiazepine with a short work. A randomized trial showed that
administration of midazolam prophylaxis in adult patients given ketamine sedation significantly decreased the risk of agitation when you wake up. According to Carl Schultz of the University of California, Irvine, USA, it is clinically important and that doctors today can be more confident giving ketamine in adult patients with joint provision of midazolam.
Agitation is defined as when recovering conscious moans, screams, curses, bad dreams, or hallucinations that are not pleasant. Agitation while recovering conscious occurred in 25% of 92 patients who were randomized to receive placebo with ketamine (1.5 mg / kg IV or 4 mg / kg IM). Agitation while recovering conscious occurred in 8% of 90 patients who received 0.03 mg / kg IV midazolam with ketamine. The increase amounted to 15% improvement in patients given ketamine IV and 19% in patients given ketamine IM. Giving together with midazolam does not affect the level of respiratory events are not expected, or the incidence of nausea and vomiting.
Previous studies conducted on 182 patients randomly received midazolam 0.03 mg / kg or placebo with ketamine 1.5 mg / kg IV or 4 mg / kg IV showed that the incidence of agitation only 8% of patients who received midazolam compared to 25% patients receiving placebo, no significant difference between patients who received ketamine IV with IM (13% vs. 17%). Sedation time is longer with IM compared with IV ketamine, midazolam but not significantly prolong sedation, so it is not true if it is mentioned that midazolam slow down time to recover from sedation. As many as 69% of patients given midazolam were satisfied compared to 48% of patients with placebo.
Based on the results of the study, clinicians can now choose to give ketamine along with midazolam for reducing the incidence of agitation caused by ketamine.
adopted from www.kalbe.co.id
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