A comparison of sedation quality with midazolam-ketamine versus propofol-ketamine during Phacoemulsification surgery

Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.

This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.

In this study, between the two groups in terms of demographic characteristics there was no significant difference (P>0.05). In the KM group, higher percentage of patients achieved the desired quality of sedation, but, between the two groups no statistically significant difference was shown (P=0.75). Surgeon satisfaction was higher in the KP group (P=0.18) and patient satisfaction was higher in the KM group (P=0.18) but there was no significant difference (P>0.05). Recovery time between groups was Similar and no statistically significant difference was shown (P>0.98). In the KM group at 5 minutes, systolic blood pressure (SBP) was notably greater than the other group (P=0.02) and diastolic blood pressure was notably greater than the KP group (P=0.08).

It can be stated that adding a small dose of ketamine to propofol and midazolam is associated with effective sedation and a similar cardiovascular response during phacoemulsification surgery.