Balanced Conscious Sedation by a Combination of Midazolam-Clonidine-Ketamine in DentalSurgery

Czech version

Authors: L. Hess ¹; V. Ščigel ²; E. Kieslichová ³; A. Březina ⁴; F. Kopáč ⁴
Authors‘ workplace: Pracoviště experimentální medicíny IKEM, Praha, přednosta doc. ing. R. Poledne, CSc. 2Laboratoř pro rizikové stomatologické pacienty IKEM, vedoucí MUDr. V. Ščigel, PhD. 3Klinika anesteziologie, resuscitace a intenzivní péče IKEM, přednosta MUDr. E. Kiesli ¹
Published in: Anest. intenziv. Med., , 2003, č. 3, s. 117-120
Category:

Overview

Objective:
A combination of midazolam-clonidine-ketamine was evaluated in terms of their influence on haemodynamic andrespiratory parameters in dental surgical patientsDesign: Non-comparative clinical study.Setting: Centre of Experimental Medicine, Prague, Department of Anaesthesiology and Resuscitation IKEM, DepartmentAnaesthesiology and Intensive Medicine – IKEM).Materials and methods: In 30 patients of both genders intravenous midazolam was administered in a total dose of 3 mg.Werecorded changes in haemodynamic and respiratory parameters caused by midazolam.After 2 minutes we added clonidine,50 µg iv, and investigated changes in haemodynamics and respiration. After the next 2 minutes racemic ketamine wasadministered, 20 mg iv.We maintained on verbal contact with the patient. Afterwards the dentist injected local anaesthetics(articain).To make sedation moreeffective,weadded midazolamin 1mg iv boluses.To enhancethe analgetic effectwe added ketamine,10 mg iv. To find out the frequency of anterograde amnesia we showed the patients photographs of objects of daily use.Weevaluated the rate of psychomotor recovery and the occurrence of side effects.Results: Conscious sedation with a combination of midazolam-clonidine-ketamine was used in a group of patientsundergoing multiple tooth extractions or extraction of an impacted wisdom tooth. Patients were able to cooperate duringthe procedure. Haemodynamic parameters and haemoglobin oxygen saturation were affected non-significantly. Midazolamand clonidine completely reversed the cardiovascular and psychomimetic effects of ketamine. There was completeanterograde amnesia of the procedure. Within 60–90 minutes after the procedure, patients were able to be escorted at homeby adults. The incidence of side effects was minimal.Conclusion: Treatment with midazolam-clonidine-ketamine further expands the range of drugs available for pharmaco-therapy.In future, racemic ketamine will be replaced by its isomer, while clonidine will be replaced by highly specificdexmedetomidine with beneficial pharmacokinetic parameters.

Key words:
midazolam – clonidine – ketamine - balanced conscious sedation technique – dental surgery

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Article was published in

Anaesthesiology and Intensive Care Medicine

2003 Issue 3