Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effects of Oral Melatonin and Intravenous Midazolame in Controlling Agitation due to Ketamine in Emergency Department; A Randomized Clinical Trial Study

Document Type : Original Article (s)

Authors
Saeed Majidinejad 1
Farhad Heydari 1
Mahdi Botshekan 2
1 Assistant Professor, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v38i580.12506
Abstract
Background: Urgent restlessness is a common condition following ketamine anesthesia in the emergency. The aim of this study was to compare the effects of intravenous midazolam, oral melatonin, and placebo in controlling of ketamine-induced agitation in adult patients undergoing minor emergency surgery.Methods: In a randomized clinical trial study, 96 patients in the emergency department who needed ketamine for sedation were divided into three groups of 32 cases. Prior to administration of ketamine, the first group received intravenous midazolam plus oral placebo, the second group received intravenous placebo and oral melatonin, and the third group received oral placebo plus intravenous placebo. The time of re-consciousness and recovery time were determined and compared in the three groups.Findings: The mean score of restlessness was significantly lower in the midazolam and melatonin groups than in the control group (P = 0.020); but there was no difference between the midazolam and melatonin groups (P > 0.999).Conclusion: According to the findings of the study, oral melatonin, as intravenous as midazolam, appears to be effective in reducing ketamine-induced agitation in anesthesia for minor emergency surgeries.
Keywords
Ketamine
Midazolam
Melatonin
Restlessness
  1. Lerman J. Does the risk scale predict emergence agitation in children? Anesth Analg 2018; 126(1): 365.
  2. Nakayama S, Furukawa H, Yanai H. Prospective, randomized comparisons of induction of anesthesia with ketamine, propofol and sevoflurane for quality of recovery from short sevoflurane anesthesia in pediatric patients. Open J Anesthesiol 2015; 5(7): 163-9.
  3. Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth 2010; 57(9): 843-8.
  4. Veyckemans F. Excitation phenomena during sevoflurane anaesthesia in children. Curr Opin Anaesthesiol 2001; 14(3): 339-43.
  5. Kim YH, Yoon SZ, Lim HJ, Yoon SM. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care 2011; 39(5): 904-8.
  6. Roelofse JA. The evolution of ketamine applications in children. Paediatr Anaesth 2010; 20(3): 240-5.
  7. Roback MG. Clinical effects and applications of ketamine. In: Absalom AR, Mason KP, editors. Total intravenous anesthesia and target controlled infusions: A comprehensive global anthology. Cham, Switzerland: Springer International Publishing; 2017. p. 245-65.
  8. Green SM, Sherwin TS. Incidence and severity of recovery agitation after ketamine sedation in young adults. Am J Emerg Med 2005; 23(2): 142-4.
  9. Chen J, Li W, Hu X, Wang D. Emergence agitation after cataract surgery in children: A comparison of midazolam, propofol and ketamine. Paediatr Anaesth 2010; 20(9): 873-9.
  10. Ozcengiz D, Gunes Y, Ozmete O. Oral melatonin, dexmedetomidine, and midazolam for prevention of postoperative agitation in children. J Anesth 2011; 25(2): 184-8.
  11. Blask DE. Melatonin, sleep disturbance and cancer risk. Sleep Med Rev 2009; 13(4): 257-64.
  12. Gitto E, Romeo C, Reiter RJ, Impellizzeri P, Pesce S, Basile M, et al. Melatonin reduces oxidative stress in surgical neonates. J Pediatr Surg 2004; 39(2): 184-9.
  13. Khalifa OSM, Hassanin AAM. Melatonin, ketamine and their combination in half doses for management of sevoflurane agitation in children undergoing adenotonsillectomy. Egypt J Anaesth 2013; 29(4): 337-41.
  14. Samarkandi A, Naguib M, Riad W, Thalaj A, Alotibi W, Aldammas F, et al. Melatonin vs. midazolam premedication in children: A double-blind, placebo-controlled study. Eur J Anaesthesiol 2005; 22(3): 189-96.
  15. Mihara T, Nakamura N, Ka K, Oba MS, Goto T. Effects of melatonin premedication to prevent emergence agitation after general anaesthesia in children: A systematic review and meta-analysis with trial sequential analysis. Eur J Anaesthesiol 2015; 32(12): 862-71.
  16. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166(10): 1338-44.
  17. Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: A randomized controlled trial. Ann Emerg Med 2011; 57(2): 109-14.
  18. Tolksdorf K, Reinhard K, Hartung K, Bauman K. Comparative study of the effects of midazolam-ketamine anesthesia and thiopental sodium induced enflurane-nitrous oxide anesthesia for minor gynecological operations. In: Domino E, editor. Status of ketamine in anesthesiology. Ann Arbor, MI: NPP Books; 1990. p. 481-90.
  19. Chudnofsky CR, Weber JE, Stoyanoff PJ, Colone PD, Wilkerson MD, Hallinen DL, et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients. Acad Emerg Med 2000; 7(3): 228-35.
  20. Ismail SA, Mowafi HA. Melatonin provides anxiolysis, enhances analgesia, decreases intraocular pressure, and promotes better operating conditions during cataract surgery under topical anesthesia. Anesth Analg 2009; 108(4): 1146-51.
  21. Nakamura N, Mihara T, Miwa T, Ka K. Prevention of emergence agitation by melatonin premedication after general anesthesia in children: Meta-analysis of randomized controlled studies. Eur J Anaesth 2014; 31: 170.
Journal of Isfahan Medical School
Volume 38, Issue 580 - Serial Number 580
May and June 2020
Pages 422-427

  • Receive Date 11 December 2019
  • Accept Date 06 April 2022