The Use of Ketamine/Midazolam Combination for Moderate Sedation in Vascular and Interventional Procedures: A Single-Institution Experience

Background: The use of ketamine in interventional radiology procedures remains historically unfavored due to the potential hallucination. Ketamine is known to induce dissociative anesthesia while maintaining airways and hemodynamics. The aim of this study is to assess the safety and effectiveness of moderate sedation using simultaneous administration of a mixture of ketamine and midazolam in interventional radiology procedures.

Materials and Methods: A retrospective cohort study was conducted of 74 consecutive patients (59.5% females) who underwent a variety of vascular and interventional procedures in a tertiary care center. The mean age was 42.2 ± 16.6 (range, 13–80). Out of 74 patients, 15 had American Society of Anesthesiologists score 1 (20.3%), 51 (68.9%) with score 2, and 8 (10.8%) with score 3.

Result: The mean dosage of ketamine was 33.9 ± 18.9 mg (range, 8–100). The mean dosage of midazolam was 1.6 (range, 0.2–5). Five patients required additional fentanyl for analgesia. The mean systolic blood pressure (BP) at baseline was 127.3 ± 22.1, the mean systolic BP during the procedure was 143.1 ± 22.1, and the mean systolic BP during recovery was 133.1 ± 18.3. The mean diastolic BP at baseline was 71.2 ± 12.1, the mean diastolic BP during a procedure was 81.1 ± 12.9, and the mean diastolic BP during recovery was 74.8 ± 12.6. Aldrete score was recorded in 72 of the patients with a mean of 9.7 ± 0.5 (range, 7–10). The Mean lowest Ramsay score during the procedure was 1.9 ± 0.5 (range, 1–3) and the mean highest Ramsay score during the procedure was 2.7 ± 0.7 (range, 2–5). Side effects were observed in five patients, self-limiting hallucinations in four patients (5.4%), and vomiting in one patient (1.4%). No cardiovascular or respiratory complications were encountered

Conclusions: The mixture of ketamine and midazolam appears to be effective in providing adequate moderate sedation and analgesia during interventional procedures with a low rate of side effects.

Publikationsverlauf

Artikel online veröffentlicht:
17. August 2022