ISSN:
1432-055X
Schlagwort(e):
Schlüsselwörter Analgodesierungsverfahren
;
Ketamin
;
Midazolam
;
Pentazocin
;
Key words Conscious sedation
;
Ketamine
;
Midazolam
;
Pentazocine
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Beschreibung / Inhaltsverzeichnis:
Abstract Ketamine and midazolam, applied as intravenous medication for conscious sedation in day-case maxillo-facial surgery, has been proven to be superior to pentazocine and midazolam concerning cardiovascular parameters and respiratory depression. The aim of this study was to evaluate the effects of low-dose ketamine/midazolam on anxiety, analgesia, amnesia and subjective feelings. Methods. 140 out-patients (ASA I) were randomly divided into four groups. The double-blind study was prospective. Control group: Local anaesthesia (LA), articaine 4% plus epinephrine 1:200000 (n=35); test group P/M: LA, additional pentazocine 0.40 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35); test group K25/M: LA, additionally ketamine 0.25 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35), test group K50/M: LA, additionally ketamine 0.5 mg/kg bw and midazolam 0.075 mg/kg bw i.v. (n=35). LA was injected 3 min after application of the systemic medication in the test groups or application of a placebo (saline 0.9%) in the control group. Three further minutes later, operation was started. For evaluation questionnaires, visual analogue scales (VAS) and the state-trait anxiety inventory (STAI) were used. For testing retrograde and anterograde amnesia, acoustic sensations were delivered before application of the systemic medication (a Christmas carol) and during operation (the German national anthem). Results. The control group and the test groups were comparable with regard to biological data, duration of operation, applied dosage of local anaesthetics and actual anxiety before operation. The patients in all test groups rated intraoperative anxiety as mild, in contrast to the control group. Nearly no pain sensation during the operation was remembered in all test groups. Retrograde amnesia was not found in any group. Complete anterograde amnesia was observed in all test groups with respect to the intraoperative sensation, but even in the control group 50% of the patients did not remember having heard the national anthem. As subjective feelings negative criteria were mainly reported in the control group, where as in all test groups positive sensations dominated. Dreams were reported mostly after the higher dosage of ketamine, but no patient experienced any unpleasant dreams. The clinical assessment of the different regimes were excellent for test groups P/M and K50/M, modest for the control group and test group K25/M. Postoperatively, patients of test group P/M were remarkably sedated, but no clinically relevant sedation or motor weakness were observed in the other groups. Postoperative pain sensations were rated more intense in all test groups than in the control group. In test groups P/M and K25/M an increasing pain level was recorded during the postoperative period, with the consequence of a higher demand rate for analgesics. Conclusions. Dental surgery can be performed safely with low-dose ketamine/midazolam. Compared to pentazocine/midazolam, the higher dosage of ketamine (0.5 mg/kg bw) showed identical results intraoperatively, but was superior during the postoperative period (vigilance), and thus may represent a suitable dosage. The lower dosage of ketamine resulted in worse operating conditions, but a dosage higher than 0.5 mg/kg bw might lead to unconscious sedation and might increase the frequency of unpleasant dreams.
Notizen:
Zusammenfassung Ketamin/Midazolam zur Analgosedierung erwies sich in bezug auf Kreislauf und Atmung gegenüber Pentazocin/Midazolam überlegen [23]. Diese Studie sollte klären, ob 0,25 oder 0,5 mg/kg KG Ketamin, 0,075 mg/kg KG Midazolam, unter den Aspekten Anxiolyse, Analgesie, Sedierung und Amnesie eine Alternative zu Pentazocin/Midazolam ist. Kontrollgruppe (KG): Lokalanästhesie (LA) mit Articain 4%/Adrenalinzusatz 1:200.000 (n=35); Testgruppe P/M: LA und 0,40 mg/kg KG Pentazocin/0,075 mg/kg KG Midazolam i.v. (n=35); Testgruppe K25/M: LA und 0,25 mg/kg KG Ketamin/0,075 mg/kg KG Midazolam i.v. (n=35); Testgruppe K50/M: LA und 0,50 mg/kg KG Ketamin/0,075 mg/kg KG Midazolam i.v. (n=35). Die LA wurde 3 min nach Analgosedierung injiziert. In den Testgruppen empfanden die Patienten intraoperativ nur geringe Angst und minimale Schmerzen. Negative Empfindungen wurden in der KG benannt, nicht in den Testgruppen. Träume (K50/M) hatten einen angenehmen Charakter. Operateur und Prüfer beurteilten Anästhesie, Kooperation und Gesamteindruck sehr gut in P/M und K50/M, schlechter in KG und K25/M. Postoperativ fiel in P/M eine stärkere Sedierung auf. Bei den postoperativen Schmerzen zeigte sich eine steigende Tendenz in den P/M und K25/M (Konsequenz: häufigere Analgetikaanforderungen). Midazolam/Ketamin ist für zahnärztlich-chirurgische Operationen geeignet: P/M und K50/M zeigten intraoperativ identische Ergebnisse, postoperativ sind K25/M und K50/M bezüglich der Vigilanz überlegen. Als ideale Dosierung von Ketamin können 0,5 mg/kg KG angesehen werden – 0,25 mg/kg KG verschlechtert die operativen Bedingungen – höhere Dosen könnten zu unerwünschten Nebenwirkungen führen.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/s001010050190
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