The effects of low-dose ketamine /midazolam conscious intravenous sedation during operations on third molars

This study examined the clinical effect of midazolam plus lowdose ketamine conscious intravenous sedation on postoperative pain and patient satisfaction with surgical extraction of third molars. Fifty patients, admitted for surgical extraction of mandibular third molars were included randomized, double blind, placebo controlled study. After injecting the initial dose of 0.03 mg/kg midazolam, the patients in group midazolamplacebo received 2 ml of an IV placebo, and the patients in group ketamine-midazolam received 2 ml of an IV ketamine and saline combination (0.3 mg/kg ketamine+saline). No significant differences in systolic blood pressure, heart rate and oxygen saturation were observed between the two groups during sedation, the diastolic blood pressure in group ketaminemidazolam was significantly higher at 5, 10, 15, 25 and 35 minutes compared to group midazolam-plasebo. The consumption of analgesics was significantly greater in group midazolam-plasebo than in group ketamine-midazolam. 22 of the patients in group midazolam-plasebo rated their satisfaction as excellent and three of the patients rated their satisfaction as good, while in group ketamine-midazolam, 23 of the patients rated their satisfaction as excellent and two as good. Conscious intravenous sedation with low-dose ketamine/midazolam is safe and reliable during extraction of third molars and may be a useful adjuvant to postoperative analgesic management.