The use of ketamine or ketamine-midazolam for adenotonsillectomy.
BACKGROUND
Ketamine's role in clinical anaesthesia is developing as a result of the evolving concepts of its mechanism of action and the advantages of its alternative routes of administration. In this study, we aimed to investigate the frequency and severity of adverse effects, specifically emergence phenomena and vomiting, when ketamine with or without midazolam used as a sole anaesthetic.


METHODS
One hundred children, aged between 3 and 10 years, scheduled for adenotonsillectomy were studied. Fifty ASA physical status I-II patients were administered ketamine and atropine intramuscularly (group K, n=50). The remaining 50 children were given ketamine, atropine and midazolam by as the same route (group KM, n=50). Noninvasive hemodynamic and oxygenation variables were monitored. Operative conditions and recovery profiles such as hallucinations, nightmares, awakening by crying agitation and retching-vomiting were investigated in 1st, 2nd, 15th, 30th and 60th days after the operation.


RESULTS
A significant reduction in emergence reactions was demonstrated especially in group KM during the early postoperative period (p<0.05). Retching-vomiting also reduced significantly in the group KM during the same time (p<0.05).


CONCLUSIONS
As a sole anaesthetic ketamine with or without midazolam provided a calm and safe anaesthesia for paediatric patients in short term procedures. In addition, it must be noted that, a better postoperative early period was achieved by ketamine with midazolam.
Erk
Gülcan
G
Department of Anaesthesiology and Reanimation, Ankara Numune Training and Research State Hospital, Turkey. gulcanerk@hotmail.com
Ornek
Dilşen
D
Dönmez
Nezihe F
NF
Taşpinar
Vildan
V
D000233:Adenoidectomy; D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D001285:Atropine / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003448:Crying; D004325:Dreams / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000139:chemically induced; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011595:Psychomotor Agitation / Q000209:etiology; D014068:Tonsillectomy; D014851:Wakefulness / Q000187:drug effects
D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D001285:Atropine; D008874:Midazolam; D010100:Oxygen