title: Effect of a combination of oral midazolam and low-dose ketamine on anxiety, pain, swelling, and comfort during and after surgical extractions of mandibular third molars.
abstract: OBJECTIVE
  To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars.
  
  
  METHODS
  Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared.
  
  
  RESULTS
  Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used.
  
  
  CONCLUSIONS
  Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.
authors.affiliation: Department of Dental Surgery, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India.
authors.forename: Rubina
authors.initials: R
authors.lastname: Gupta
authors.forename: Kiran
authors.initials: K
authors.lastname: Sharma
authors.forename: Umesh Kumar
authors.initials: UK
authors.lastname: Dhiman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D001007:Anxiety / Q000517:prevention & control*; D016854:Dental Anxiety / Q000145:classification / Q000517:prevention & control; D004338:Drug Combinations; D004487:Edema / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage*; D008334:Mandible / Q000601:surgery; D008874:Midazolam / Q000008:administration & dosage*; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam