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Showing 8 results for Sedation
Propofol-alfentanyl versus midazolam-ketamine for sedation and analgesia during bone marrow spiration in children
Darabi M.a, Mireskandari S.m, Sadeghi M,
Volume 65, Issue 6 (9-2007)
Abstract
Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharmacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.
Methods: Fifty children with oncologic malignancies whose ages ranged between 2-12 years were enrolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.
Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001). After Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.
Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.
Rectal premedication in pediatric anesthesia: midazolam versus ketamine
Ebrahim Soltani A, Arbabi Sh, Nahvi H, Moshirian N,
Volume 66, Issue 2 (5-2008)
Abstract

Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.

Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale.

Results: Neither medication showed acceptable sedation (>75%), with no significant difference in sedation score between the two groups (P=0.725). Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively). Ease of parental separation was seen in both groups without significant difference (P=0.288) and no major adverse effects, such as apnea, occurred in either group.

Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.


The effect of hypnotic drug type on anesthetic depth and amnesia: a randomized clinical trial
Amiri Hr, Makarem J, Noyan Ashraf Ma,
Volume 67, Issue 3 (6-2009)
Abstract

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Bispectral index (BIS index) shows the depth of anesthesia. The effects of drugs on BIS and amnesia are different. This study was performed to evaluate the association between two different sedative regimens on BIS and amnesia.
Methods: In this clinical trial, 60 patients who needed elective orthopedic surgery under regional anesthesia with intravenous sedation were elected. Patients divided in two equal groups based on sedation protocol by block randomization method: midazolam plus fentanyl group (MF group) or propofol group (P group). Dose of sedative drugs were adjusted according to clinical findings of sedation. Depth of sedation in all patients, preserved in four based on modified Ramsey Sedation Score. Patients questioned about spontaneous recall after full awakening in recovery room. Recall of any event during operation considered as failed amnesia. Correlation of BIS index with recall was measured in two different groups separately.
Results: The frequency of recall was 2 (6.7%) in P group and 10 (33.3%) in MF group (p=0.01). The mean± SD of BIS in P group was 76±5 (68-91) and in MF group was 93.4±5 (77-98) (p<0.001). The difference of BIS in patients without amnesia (p=0.019) and with amnesia (p<0.001) in two groups were significant, respectively. No delay in recovery was observed.
Conclusion: Although the Modified Ramsey Sedation Score and clinical sedation indices were the same, but BIS in patients varied in a wide range. Hypnotic drug was a main determinant of BIS score and amnesia.


The effect of aging on bispectral index before and after sedation: a prospective study
Mahoori A, Noroozinia H, Hassani E, Motargemzadeh G, Sadeghi A,
Volume 68, Issue 5 (8-2010)
Abstract

Background: The Bispectral Index (BIS) is an EEG-derived value that measures the sedative and hypnotic component of the anesthetic state. The effects of age on the bispectral index have not been well documented. The objective of the present study was to determine the influence of age on hypnotic requirement and bispectral index in awake and in patients with sedation induced by midazolam.

Methods: Eighty patients were enrolled in this prospective observational study. The patients in study group were aged more than 70 years, and the age in control group ranged 20-40 years. Baseline recording of BIS was taken in awake patients in two groups for few minutes. Five minutes after administration of 0.02 mg/kg IV midazolam the BIS value also was taken and recorded.

Results: In the study group, patients had a mean base BIS 94±3 compared with 97.3±1 in the control group (p< 0.0001). Five minutes after administration of 0.02 mg/kg midazolam the value were 80.9±6 and 90.4±3 respectively (p< 0.0001).

Conclusion: When BIS is used as a monitor of hypnosis in the elderly, we recommend that a baseline recording be taken before induction for a few minutes to alert the anesthesia provider to the possibility of low initial values. Further studies are needed to verify if the recommended range of 50-60 of BIS during clinical anesthesia is also adequate in the elderly with low initial baseline BIS or if this range needs adjusting in view of reduced initial BIS value.
The comparison of efficacy and complications of two premedication agents, midazolam-ketamine and midazolam-fentanyl in adult patients who underwent cataract surgery
Mehdi Sanatkar , Mehrdad Goudarzi ,
Volume 77, Issue 3 (6-2019)
Abstract
Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.

Comparison of the efficacy of two pre-treatment medication of dexmedetomedine-fentanyl and midazolam-fentanyl in cataract surgery
Mehdi Sanatkar , Mehrdad Goudarzi , Ebrahim Espahbodi ,
Volume 78, Issue 3 (6-2020)
Abstract
Background: Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.

A comparison of sedation quality with midazolam-ketamine versus propofol-ketamine during Phacoemulsification surgery
Hamidreza Shetabi, Seyed Morteza Haidari , Darush Moradi Farsani , Zahra Bechari,
Volume 79, Issue 1 (4-2021)
Abstract
Background: Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.
Methods: This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.
Results: In this study, between the two groups in terms of demographic characteristics there was no significant difference (P>0.05). In the KM group, higher percentage of patients achieved the desired quality of sedation, but, between the two groups no statistically significant difference was shown (P=0.75). Surgeon satisfaction was higher in the KP group (P=0.18) and patient satisfaction was higher in the KM group (P=0.18) but there was no significant difference (P>0.05). Recovery time between groups was Similar and no statistically significant difference was shown (P>0.98). In the KM group at 5 minutes, systolic blood pressure (SBP) was notably greater than the other group (P=0.02) and diastolic blood pressure was notably greater than the KP group (P=0.08).
Conclusion: It can be stated that adding a small dose of ketamine to propofol and midazolam is associated with effective sedation and a similar cardiovascular response during phacoemulsification surgery.
 

Comparative study of the sedative effect of ketamine-dexmedetomidine (Ketodex)with ketamine-midazolam(Ketomid) in candidates of fibroptic bronchoscopy
Behzad Nazemroaya , Samin Jahanbin,
Volume 80, Issue 8 (11-2022)
Abstract
Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).
Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure.
Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

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