Effectiveness of low-dose midazolam plus ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery

Karis Misiran, F. Z. Aziz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: This study was conducted to compare the effectiveness of two different dosages of intravenous midazolam in combination with ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery. Design: This was a prospective, randomised, double-blind, placebo-controlled study. Setting and subjects: We studied 90 patients with American Society of Anesthesiologists classification I and II, aged between 18 and 60 years old, and randomly allocated to receive either a combination of low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg (Group A), or a combination of higher-dose midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg (Group B), or normal saline as the control group (Group C), after an intrathecal injection of 0.5% hyperbaric bupivacaine 12.5-15 mg. Outcome measures: The outcomes measured were the incidence and the degree of shivering, the effectiveness and the side-effects of two different dosages of the drugs in preventing shivering. Results: In this study, the incidence of shivering was 46% in Group C, which was significantly higher than that in Group A (16%) and Group B (10%) (p-value < 0.05). However, there was no difference between Group A and B (p-value = 0.704). The number of patients with shivering grade ≥ 2 was significantly higher in Group C than it was in Groups A and B (p-value < 0.05), but not between Group A and Group B. It was also found that there was no difference in the haemodynamic parameters in all three groups. However, patients in Groups A and B were more sedated (p-value < 0.05), and had higher incidence of nystagmus than those in Group C (p-value < 0.001). Conclusion: Low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg was equally effective when compared with a higher dose of midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg in preventing shivering during spinal anaesthesia for emergency lower limb surgery. There were no significant changes in the haemodynamic parameters in all three groups. However, patients in the midazolam plus ketamine groups were more sedated and had a higher incidence of nystagmus.

Original languageEnglish
Pages (from-to)164-170
Number of pages7
JournalSouthern African Journal of Anaesthesia and Analgesia
Volume19
Issue number3
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Shivering
Spinal Anesthesia
Midazolam
Ketamine
Lower Extremity
Emergencies
Incidence
Hemodynamics
Spinal Injections
Bupivacaine
Cohort Studies
Placebos
Outcome Assessment (Health Care)
Control Groups
Pharmaceutical Preparations

Keywords

  • Emergency lower limb surgery
  • Ketamine
  • Midazolam
  • Spinal anaesthesia
  • Temperature

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{f7d8da6eb7fb412fa8c996737a176c42,
title = "Effectiveness of low-dose midazolam plus ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery",
abstract = "Objective: This study was conducted to compare the effectiveness of two different dosages of intravenous midazolam in combination with ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery. Design: This was a prospective, randomised, double-blind, placebo-controlled study. Setting and subjects: We studied 90 patients with American Society of Anesthesiologists classification I and II, aged between 18 and 60 years old, and randomly allocated to receive either a combination of low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg (Group A), or a combination of higher-dose midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg (Group B), or normal saline as the control group (Group C), after an intrathecal injection of 0.5{\%} hyperbaric bupivacaine 12.5-15 mg. Outcome measures: The outcomes measured were the incidence and the degree of shivering, the effectiveness and the side-effects of two different dosages of the drugs in preventing shivering. Results: In this study, the incidence of shivering was 46{\%} in Group C, which was significantly higher than that in Group A (16{\%}) and Group B (10{\%}) (p-value < 0.05). However, there was no difference between Group A and B (p-value = 0.704). The number of patients with shivering grade ≥ 2 was significantly higher in Group C than it was in Groups A and B (p-value < 0.05), but not between Group A and Group B. It was also found that there was no difference in the haemodynamic parameters in all three groups. However, patients in Groups A and B were more sedated (p-value < 0.05), and had higher incidence of nystagmus than those in Group C (p-value < 0.001). Conclusion: Low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg was equally effective when compared with a higher dose of midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg in preventing shivering during spinal anaesthesia for emergency lower limb surgery. There were no significant changes in the haemodynamic parameters in all three groups. However, patients in the midazolam plus ketamine groups were more sedated and had a higher incidence of nystagmus.",
keywords = "Emergency lower limb surgery, Ketamine, Midazolam, Spinal anaesthesia, Temperature",
author = "Karis Misiran and Aziz, {F. Z.}",
year = "2013",
language = "English",
volume = "19",
pages = "164--170",
journal = "Southern African Journal of Anaesthesia and Analgesia",
issn = "2220-1181",
publisher = "In House Publications",
number = "3",

}

TY - JOUR

T1 - Effectiveness of low-dose midazolam plus ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery

AU - Misiran, Karis

AU - Aziz, F. Z.

PY - 2013

Y1 - 2013

N2 - Objective: This study was conducted to compare the effectiveness of two different dosages of intravenous midazolam in combination with ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery. Design: This was a prospective, randomised, double-blind, placebo-controlled study. Setting and subjects: We studied 90 patients with American Society of Anesthesiologists classification I and II, aged between 18 and 60 years old, and randomly allocated to receive either a combination of low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg (Group A), or a combination of higher-dose midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg (Group B), or normal saline as the control group (Group C), after an intrathecal injection of 0.5% hyperbaric bupivacaine 12.5-15 mg. Outcome measures: The outcomes measured were the incidence and the degree of shivering, the effectiveness and the side-effects of two different dosages of the drugs in preventing shivering. Results: In this study, the incidence of shivering was 46% in Group C, which was significantly higher than that in Group A (16%) and Group B (10%) (p-value < 0.05). However, there was no difference between Group A and B (p-value = 0.704). The number of patients with shivering grade ≥ 2 was significantly higher in Group C than it was in Groups A and B (p-value < 0.05), but not between Group A and Group B. It was also found that there was no difference in the haemodynamic parameters in all three groups. However, patients in Groups A and B were more sedated (p-value < 0.05), and had higher incidence of nystagmus than those in Group C (p-value < 0.001). Conclusion: Low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg was equally effective when compared with a higher dose of midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg in preventing shivering during spinal anaesthesia for emergency lower limb surgery. There were no significant changes in the haemodynamic parameters in all three groups. However, patients in the midazolam plus ketamine groups were more sedated and had a higher incidence of nystagmus.

AB - Objective: This study was conducted to compare the effectiveness of two different dosages of intravenous midazolam in combination with ketamine in the prevention of shivering during spinal anaesthesia for emergency lower limb surgery. Design: This was a prospective, randomised, double-blind, placebo-controlled study. Setting and subjects: We studied 90 patients with American Society of Anesthesiologists classification I and II, aged between 18 and 60 years old, and randomly allocated to receive either a combination of low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg (Group A), or a combination of higher-dose midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg (Group B), or normal saline as the control group (Group C), after an intrathecal injection of 0.5% hyperbaric bupivacaine 12.5-15 mg. Outcome measures: The outcomes measured were the incidence and the degree of shivering, the effectiveness and the side-effects of two different dosages of the drugs in preventing shivering. Results: In this study, the incidence of shivering was 46% in Group C, which was significantly higher than that in Group A (16%) and Group B (10%) (p-value < 0.05). However, there was no difference between Group A and B (p-value = 0.704). The number of patients with shivering grade ≥ 2 was significantly higher in Group C than it was in Groups A and B (p-value < 0.05), but not between Group A and Group B. It was also found that there was no difference in the haemodynamic parameters in all three groups. However, patients in Groups A and B were more sedated (p-value < 0.05), and had higher incidence of nystagmus than those in Group C (p-value < 0.001). Conclusion: Low-dose midazolam 0.02 mg/kg plus ketamine 0.25 mg/kg was equally effective when compared with a higher dose of midazolam 0.04 mg/kg plus ketamine 0.25 mg/kg in preventing shivering during spinal anaesthesia for emergency lower limb surgery. There were no significant changes in the haemodynamic parameters in all three groups. However, patients in the midazolam plus ketamine groups were more sedated and had a higher incidence of nystagmus.

KW - Emergency lower limb surgery

KW - Ketamine

KW - Midazolam

KW - Spinal anaesthesia

KW - Temperature

UR - http://www.scopus.com/inward/record.url?scp=84879548985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879548985&partnerID=8YFLogxK

M3 - Article

VL - 19

SP - 164

EP - 170

JO - Southern African Journal of Anaesthesia and Analgesia

JF - Southern African Journal of Anaesthesia and Analgesia

SN - 2220-1181

IS - 3

ER -