Low dose ketamine and midazolam as supplements for spinal anesthesia

Low dose ketamine and midazolam together were used as supplements during spinal anesthesia to provide analgesia for insertion of spinal needle and intraoperative sedation.

Two regimens of drug combination (ketamine 0.5 mg/kg and midazolam 0.05 mg/kg in group I, n = 30; ketamine 0.5 mg/kg and midazolam 0.1 mg/kg in group II, n = 30) were administered intravenously before proceeding lumbar puncture.

Systolic and diastolic arterial blood pressure, heart rate, and arterial oxygen saturation did not change significantly before and after the administration of drugs. Most patients in both groups showed good analgesic response to the lumbar puncture. The medications induced a brief unconsciousness (4.1 min in group I; 8.5 min in group II). The time from drug administration to recovery of mental orientation was 8.8 min in group I and 15.1 min in group II. The regimens also provided intraoperative sedation. Patients in group II appeared to be more depressed than group I in the first 30 min. None of the patients had significant respiratory disturbance, involuntary movement, or recall to spinal puncture. There were 7 patients in group I and 4 patients in group II who experienced dreaming.

The use of low dose ketamine together with midazolam as supplement for spinal anesthesia is helpful in anesthetic practice.