1 Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

2 Department of Anesthesia, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India


Objective: 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.
Methods: 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 
Findings: 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.
Conclusion: 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.


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