The use of ketamine or ketamine-midazolam for adenotonsillectomy

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.

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.

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).

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.