Effects of adding midazolam to ketamine and fentanyl combination in a burn wound dressing in adults

Aim: It was aimed to investigate the effects and side effects of adding midazolam to ketamine and fentanyl combination on sedation, hemodynamic stability and recovery rate during burn debridement and dressing in adult patients. Material and Methods: ASA I-II group, adult patients aged between 18-70 years, who were going to undergo therapeutic procedures such as change of burn dressings and debridement, were included in the study. The cases were randomly divided into two groups. The ketamine/fentanyl group (Group KF) received 1 mg/kg ketamine i.v and 1 mcgr/kg fentanyl just before the dressing. In the ketamine+midazolam/fentanyl group (Group MKF), 0.03 mg/kg midazolam was additionally administered 10 minutes before the procedure. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), peripheral oxygen saturation (sPO2), respiratory rate (RR) were monitored and recorded every 5 minutes. The results were evaluated at the 95% confidence interval and the significance level was p<0.05. Results: Fifty-nine patients aged between 15-56 years (29.98 +/- 9.22 years) were included in the study. Six patients (10.2%) were female and 53 (89.8%) were male. There was no statistically significant difference between the KF-MKF groups in terms of age, weight and gender, burn rate, ASA distribution, dressing time, and additional dose requirement values (p>0.05). SBP0, SBP5, SBP10, SBP15 values, DBP0, DBP5 values and HR0, HR5 values of the subjects in the KF group were found to be statistically significantly higher than the values of subjects in the MKF group (p<0.05). Discussion: Combinations of midazolam-ketamine/fentanyl and ketamine/fentanyl provide effective sedation in burn debridement and dressing in adult patients. It was concluded that the addition of midazolam to the ketamine/fentanyl combination provides better hemodynamic stability.