Combination of Ketamine-Midazolam Infusion and Local Infiltration with 0.25% Bupivacaine for Diagnostic Gynaecologic Laparoscopy
Abstract
Background : Gynaecologic laparoscopy is useful for both diagnosis and treatment. The procedure is performed via a few small incision wounds on the abdomen. The degree of pain is believed to be less than the conventional surgical wound.
Objective : To assess the efficiency of the combination of ketamine-midazolam infusion and local infiltration with 0.25% bupivacaine and side effects to patients.
Design : A descriptive study.
Setting : At srinagarind hospital.
Subjects : A combination of ketamine - midazolam infusion and local infiltration with 0.25% bupivacaine for diagnostic gynaecologic laparoscopy was completely done in 50 cases of the female patients, ASA physical status I-II.
Intervention : The anesthetic agents used were 0.4 mg of atropine, 0.05 mg/kg of midazolam and 1 up/kg of fentanyl for premedication. The induction was started with ketamine 1 mg/kg and then continuously infused with the mixture of ketamine 100 mg and midazolam 5 mg at the rate of 0.02 mg/kg/min of ketamine and local infiltration with 20 ml of 0.25% bupivacaine was done at 1 cm below the umbilicus. This technique in fan-like shape was rapid, smooth, safe and without serious complications.
Measurements : Systolic and diastolic blood pressure, heart rate, respiratory rate and clinical signs during surgery and side effects of drugs in recovery room.
Results : This technique was rapid, smooth, safe and with out serious complications. It was found that the blood pressure and heart rate increased when compared to the preinduction period. There was a significant difference by the paired t-test (p < 0.05), however, all of the studying value were in normal clinical range.
Conclusions : This technique may be recommended as another choice of anesthesia for gynecologic laparoscopy for its simplicity and effectiveness.
