| Clinical Study of Endotracheal Anesthesia with Lorazepam-Ketamine-Alcuronium . |
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Hae Keum Kil, Duck Mi Yoon, Hung Kun Oh |
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Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
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The effect of various drugs on the incidence and severity of hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia were investigated in many studies.
Lorazepam is a psychotropic agent of the benzodiazepine class. similar in action to, but more potent than, diazepam.
This study was carried out to investigate the efficiency of the ketamine I.V. drip technique under endotracheal intubation with a combination of nitrous oxide, oxygen, muscle relaxant and controlled ventilation. The only contraindications to the use of this technique were hypertension, a history of cerebrovascular disease or psychotic upset. Eighteen patients, ranging in age from 20 to 60 years, were premedicated with I.M. atropine sulfate and oral lorazepam (2mg/kg) administration. Anesthesia was induced with 1.5~2,0mg/kg ketamine and 0.03~0.04mg/kg alcuronium, before intubation. Anesthesia was maintained by dripping 0. l% ketamine in 5% dextrose in water, with N2O and 02, The average dosage of ketamine was l. 685mg/kg for induction and 0.011mg/kg/min for maintenance during operations with a duration of from 55 to 275 minutes.
Alcuronium is a non-depolarizing muscle relaxant and a derivative of C-toxiferine l. It has a little ganglionic blocking effect. The increase of blood pressure after endotracheal intubation was not significant. The incidence of complications of anesthesia was increased blood pressure 16. 7% (20mmHg above preop. value), tachycardia 38. 9% , dreams 5. 6 % and hallucination 5. 6%. Also oral premedication with lorazepam provided significant anterograde amnesia in all patients. It may be concluded that a combination of oral premedication by lorazepam and ketamine I.V. drip anesthesia with N2,O, O2 and alcuronium, followed by endotracheal intubation, can be used relatively satisfactorily in explo-laparatory operations in which muscle relaxation is needed. |
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