[Oral ketamine-midazolam premedication of uncooperative patients in major outpatient surgery]. / Premedicación con ketamina-midazolam oral en pacientes no colaboradores en cirugía mayor ambulatoria.

ABSTRACT

BACKGROUND: Currently, ketamine is not often used as an anesthetic. Its clinical characteristics and mechanism of action largely depend on antagonism of the N-methyl-D-aspartate receptor. OBJECTIVE: To evaluate the utility of oral ketamine as a preanesthetic agent to lower surgical stress for patients with mental disability. MATERIAL AND METHODS: Observational, retrospective study of 112 mentally disabled patients undergoing major dental surgery on an outpatient basis. The study group received oral midazolam, ibuprofen, and 6 mg/kg of ketamine; the control group received only midazolam and ibuprofen. We recorded data concerning demographics, anesthesia, surgery, physiologic variables, Glasgow score, time of onset of anxiolysis, duration of stay in the recovery ward, and adverse events. RESULTS: Conservative odontologic treatment was provided in 66.3% of the cases. Seventy-one patients (64.4%) were in the control group and 41 patients (36.6%) in the study group. Hemodynamic, respiratory, and neurologic changes were minimal and there were no significant between-group differences. Level of sedation differed significantly between groups (P = .001) at 15 and 30 minutes; differences were also observed within the study group. Mean (SD) duration of surgery was 72.6 (29.7) minutes. Mean duration of stay in the postoperative recovery ward was 140.9 (52.1) minutes (135.8 [54.89] minutes in the study group and 144.2 [50.5] minutes in the control group). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS: Oral ketamine is an effective premedication for major ambulatory surgery and does not increase the incidence of side effects.