A COMPARISON OF SEDATION TECHNIQUES FOR OUTPATIENT RHINOPLASTY - MIDAZOLAM VERSUS MIDAZOLAM PLUS KETAMINE

A total of 859 patients presenting for outpatient rhinoplasty were div ided into two groups that received intravenous sedation of midazolam 0 .1 mg/kg either with or without ketamine 0.4 to 0.5 mg/kg immediately prior to conduct of the local anesthetic injections and surgery. Addit ional midazolam was given intraoperatively as needed. No patient recei ved narcotic either as premedication or intraoperatively. Patients wer e evaluated by the surgeon on their response to the injections and sur gery, and patients were given a questionnaire 1 week postoperatively t o examine their response to and recall of the procedure. Scoring by bo th the surgeon and patients revealed that b the great majority of pati ents in both groups had adequate ''sedation.'' Patients from both grou ps related a high degree of satisfaction (>90 percent) with the techni que of sedation. The differences between the two study groups achieved statistical significance only on 4 of the 12 parameters investigated. Those who had received only midazolam were less likely to Vocalize du ring the surgery or to experience the procedure as being of undue dura tion. Those who had also received ketamine had a lesser chance of reme mbering the local anesthetic injections (11.1 versus 19.8 percent) and a lesser likelihood of being dissatisfied with their surgical experie nce (3.3 versus 7.4 percent) In conclusion, the use of an opioid-free sedative technique of intravenous midazolam was highly successful in m eeting the needs of both patients and surgeons. The addition of a sing le preblock dose of intravenous ketamine to intravenous midazolam seda tion for rhinoplasty does not improve intraoperative conditions for th e surgeon in terms of patient behavior. Neither does it improve the pa tients' experience of the surgery itself. It does, however, roughly ha lve the number of patients remembering the local anesthetic injection and those expressing dissatisfaction with the overall experience of rh inoplasty surgery.