Premedication before elective breast surgery, a comparison between ketobemidone and midazolam

Abstract

One hundred female patients scheduled for elective breast surgery (mean age 60 +/- 11 years were randomly assigned to receive one of two premedications: ketobemidone (Ketogan) 1-1.5 ml or midazolam 4-5 mg, intramuscularly. The effects on preoperative anxiety and postoperative emetic sequelae were studied. All patients were anaesthetised with thiopentone, fentanyl and atracurium, and ventilated with a mixture of nitrous oxide in oxygen with supplementary isoflurane. Sixty-nine percent of the midazolam- and 50% of the ketobemidone-premedicated patients experienced a reduction in anxiety. Midazolam was found to be more effective than ketobemidone in reducing anxiety among more tense patients--those with a VAS grading before premedication of 2 or more (P less than 0.05). Midazolam-premedicated patients were also assessed by observers as being more relaxed (P less than 0.05). No difference was seen in the frequency of emetic sequelae: 20 patients in the midazolam group and 14 patients in the ketobemidone group vomited once or more during the 24-h observation period. There was no difference between the two groups in time until an analgetic was required. In conclusion, midazolam seemed more effective in reducing preoperative anxiety than ketobemidone without any negative effects on postoperative emesis or time until an analgetic was required.

Prophylaxis of postoperative nausea and vomiting in elective breast surgery

“…Based on previously published data, the incidence of PONV in patients undergoing elective breast surgery is as high as 50% [2,3]. A relative reduction in PONV incidence by 50% would be considered clinically relevant.…”

“…The incidence of PONV in patients undergoing elective breast surgery is reported to be as high as 50% [1,2].…”

Oral premedication one hour before minor gynaecological surgery — does it have any effect?

“…Kamath et al did find temazepam associated with a lower frequency compared to placebo (35). In a previous study we could see no major differences in postoperative nausea and vomiting comparing intramuscular premedication with midazolam and ketobemidone (36). We conclude that routine oral premedication with a small dose of benzodiazepine, opioid or a beta-blocker one hour before elective laparoscopy surgery does not provide any advantage compared to placebo and could probably be omitted.…”

Benefits and Risks of Granisetron Versus Ramosetron for Nausea and Vomiting after Breast Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

“…1,2 A previous study found the incidence of PONV to be as high as 50% in patients undergoing general anesthesia for breast surgery. 1,2 In this clinical trial, the incidence of emetic symptoms was 47% 0-24 hours after anesthesia and 53% 24-48 hours after anesthesia in patients who had received placebo. The etiology of PONV is complex and is dependent on a variety of factors, which include age, gender, obesity, a history of motion sickness and/or previous postoperative emesis, menstruation, smoking, operative procedure, anesthetic technique, and postoperative pain.…”

“…1,2 Most currently used antiemetics (antihistamines, butyrophenones, dopamine receptor antagonists) have been reported to occasionally cause undesirable adverse events, such as excessive sedation, hypotension, dry mouth, dysphoria, hallucinations, and extrapyramidal symptoms. 3 The US Food and Drug Administration recently issued a warning about the risk of dysrhythmogenic effects, such as prolonged QT syndrome, with droperidol.…”