SAAD Digest 

September 2026
Volume: 42
Issue: 2

DOI: 10.63507/DKRP4521

Title: The use of combined oral midazolam-ketamine as a pre-anaesthetic agent for special care adults requiring dental treatment under general anaesthesia: a service evaluation

Author(s): M. Roberts, M. Burtonwood, A. Muthukrishnan

Abstract:
Background
Pre-anaesthetic sedative agents can facilitate safe and effective induction of general anaesthesia for adult patients with cognitive impairments. Typically, benzodiazepines such as midazolam are administered for this purpose. However, the use of an oral midazolam-ketamine combination is thought to provide positive synergistic effects compared with oral midazolam alone.

Methodology
This service evaluation outlines the use of pre-anaesthetic sedative agents for adult cognitively impaired patients requiring day case general anaesthesia for comprehensive dental care. A retrospective review of 62 patients treated over a 14-month period was undertaken, with 17 of these receiving the oral midazolam-ketamine pre-anaesthetic agent.

Results
Successful induction of general anaesthesia was possible for all patients and no significant patient safety events occurred. The average time between administration of the pre-anaesthetic agent and induction of general anaesthesia was slightly longer for the oral midazolam-ketamine group compared to oral midazolam alone (25 mins compared with 22 minutes). Average total recovery time for patients receiving oral midazolam-ketamine was shorter than those who received oral midazolam alone.

Conclusion
Combined oral midazolam-ketamine appears to be a safe and effective pre-anaesthetic agent for adults with cognitive impairments, but further study in this patient demographic is required.

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