RESUMEN
This study was conducted on 16 patients submitted to closed mitral commissurotomy surgery. They were randomly classified into two groups eight patients each. The first group recieved thiopentone-for induction and isoflourane-vecronium for maintenance The second group received kjtamine-midazolam for induction and then followed by continuous infusion according to a pharmacokinetics based multistepped decreasing regimen. Arterial cannulation and pulmonary artrey catheter were fixed to measure the haemodynamic variables at 5 time points before and during surgery. Data are collected and analysed statistically to compare both groups and record changes during the course of surgery inside each group. The results showed non significant changes between the two groups regarding the haemodynamic parameters recorded, but the systemic vascular resistance [SVR] was significantly increased in the isoflourane group at post-commissurotomy time point. In conclusion, TIVA with ketamine-midazolam can provide a pattern of haemodynamic stability during mitral valve stenosis surgery comparable to that of isoflurane. Concomitant ad-minsteration of midazolam to ketamine according to the regemin used in this study almost neutralized the cardiovascular effects of ketamine