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Induction Dose—Response Curves for Midazolam and Ketamine in Premedicated ASA Class III and IV Patients

The Departments of Anesthesia, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania.

Abstract

Using probit analysis, dose-response curves for induction of anesthesia with midazolam or ketamine were constructed in ASA class III and IV patients premedicated with morphine, 0.1 mg/kg, and glycopyrrolate, 4 µg/kg. For ketamine, ED₅₀ values for abolition of the response to verbal commands, eyelash stimulation, and painful stimulation were 0.9, 1.3, and 1.3 mg/kg, respectively; corresponding ED₉₅ values were 1.6, 2.3, and 4.3 mg/kg, which are within the range of clinically recommended doses. For midazolam, ED₅₀ values for verbal commands, eyelash stimulation, and painful stimulation were 0.19, 0.24, and 0.36 mg/kg, significantly greater than those previously reported for unpremedicated ASA class I and II patients. The corresponding ED₄₅ values, 0.35, 0.43, and 1.04 mg/kg exceed previously reported values and are appreciably greater than the doses used in most previous studies of midazolam induction

Midazolam decreased systolic blood pressure slightly but significantly (from 138 ± 4 to 128 ± 4 mm Hg, · sem, P < 0.005), while diastolic blood pressure and heart rate remained unchanged. In contrast, ketamine increased systolic blood pressure (from 141 ± 4 to 164 ± 5 mm Hg, P < 0.005), diastolic blood pressure (from 71 ± 3 to 88 ± 4 mm Hg, P < 0.005), and heart rate (from 84 ± 2 to 102 ± 4 beats/min, P < 0.005). On the basis of these data, we conclude that in ASA class III and IV patients, midazolam induction allows for hemodynamic stability and avoids the significant tachycardia and hypertension associated with equipotent doses of ketamine

Key Words: INDUCTION, ANESTHESIA—midazolam, ketamine.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999