[Combined midazolam-ketamine anesthesia in traumatologic interventions. Patterns of endocrine reactions]

For anesthesia, ataranalgesic combinations of benzodiazepines and ketamine have been reported to be advantageous alternatives to inhalation agents or high-dose opioids. In this study, the influence of midazolam-ketamine-N2O/O2 anesthesia on the endocrine metabolic response of patients during the course of reconstructive orthopedic surgery (n = 8) was investigated. METHODS. The dosage of anesthetic agents was calculated according to body weight. Thus, the amount of ketamine given in young adults (mean age = 24.1 years) was 30 micrograms/kg per minute. Pre-, intra-, and postoperatively, each of following hormones was measured by either radioimmunoassay or radioenzyme-linked assay: ACTH, aldosterone, cortisol, 17-dehydroepiandrosterone (17-DHEA), prolactin, insulin, T3, T4, thyroxine-binding globulin (TGB), epinephrine, norepinephrine, and dopamine. Additionally, the metabolites glucose, lactate, and free glycerin were measured perioperatively. RESULTS and CONCLUSION. The circulation remained relatively stable under midazolam-ketamine-N2O/O2 anesthesia (MAP +23%; HR +17%). ACTH secretion and prolactin secretion showed a significant rise (p less than 0.01) even before skin incision (Figs. 1, 3). A significant rise in cortisol levels occurred intraoperatively (+80%; p less than 0.01). Secretion of aldosterone (+246%; p less than 0.05) and 17-DHEA (+49%; p less than 0.05) essentially followed the secretory profile of cortisol, while insulin secretion did not rise significantly under acute surgical stress (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)