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The effect of variable-dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine-fentanyl anaesthesia.

R F Grace

Anaesthesia September 1, 2003 DOI: 10.1046/j.1365-2044.2003.03341.x (opens in new tab)

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Characteristics Randomized double-blind field study Peer reviewed
Sample size 400
Population Melanesian patients undergoing anesthesia
Interventions Diazepam Ketamine Fentanyl
Dose diazepam 0, 0.025, 0.05, 0.1, 0.175 mg/kg; ketamine 1 mg/kg; fentanyl 1 microg/kg
Topics Ketamine Dreaming Esketamine
Keywords Humans Delirium Fentanyl Diazepam Adjuvants, anesthesia Anesthetics, combined Anesthetics, dissociative Anesthesia recovery period Double-blind method Dreams Blood pressure Heart rate Dose-response relationship, drug Adult Middle aged Patient satisfaction Female
Key points Adding at least 0.1 mg/kg diazepam to ketamine-fentanyl anesthesia significantly reduced dreaming (67.5% vs 94.6%) and emergence delirium scores (median 4 vs 6) compared with water, and blunted blood pressure and heart rate increases; higher diazepam doses did not further improve dream experience or benefits.

Abstract

This randomised double-blind field study compared 400 anaesthetics using diazepam (0, 0.025, 0.5, 0.1, 0.175 mg.kg-1) with ketamine (1 mg.kg-1) and fentanyl (1 microg.kg-1) in Melanesian patients. Dreams were very common and generally positive in nature. A minimum of 0.1 mg.kg-1 of diazepam was needed to significantly reduce dreaming when compared with water (67.5% vs. 94.6%; p < 0.0001), and to significantly lower median (95% CI) emergence delirium scores (4 (3-4) vs. 6 (5-7)). Gender and age did not affect the rate of dreaming. Increasing the dose of diazepam did not improve the dream experience. Patient satisfaction scores were similar between groups. Increases in blood pressure and heart rate were greater in dreamers than in non-dreamers. All groups had high rate-pressure products but this was highest when diazepam was not used. Higher diazepam doses significantly reduced the increase in blood pressure and heart rate at 3 and 6 min postketamine. When used with ketamine and fentanyl, 0.1 mg.kg-1 of diazepam has favourable psychic and cardiovascular effects. Lower diazepam doses generally had little effect whereas larger doses did not enhance the benefits further.

Comparable studies

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Study Year Design Participants
Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Combat veterans of Operation Enduring Freedom and/or Operation Iraqi Freedom (mean age... 2013 Randomized controlled trial n = 40
Lucid Dreaming Treatment for Nightmares: A Pilot Study Chronic nightmare sufferers 2006 Randomized controlled trial n = 23
Testing the involvement of the prefrontal cortex in lucid dreaming: A tDCS study Participants spending three consecutive nights in a sleep laboratory 2013 Randomized controlled trial n = 19
Pre-sleep treatment with galantamine stimulates lucid dreaming: A double-blind, placebo-controlled, crossover study Adults with high dream recall and an interest in lucid dreaming 2018 Randomized crossover trial n = 121
Studies with lucid dreaming as add-on therapy to Gestalt therapy Adults with nightmares (ICD-10: F51.5) at least twice a week 2015 Randomized controlled trial n = 32

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