الفهرس 
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Abstract
This prospective double blinded study was conducted in El Minia University Hospital during the period from October 2016 to April 2017, after getting approval from our hospital Ethics Committee.
Ninety patients aged between 18 and 60 years old as ASA I and II scheduled for elective surgeries under spinal anesthesia were included in this study.
The aim of our study was to compare the efficacy of ketamine/midazolam combination versus propofol/fentanyl combination in decreasing procedural discomfort during establishment of spinal anesthesia and side effects of them.
After standard monitoring of noninvasive blood pressure and pulse oximetry, the patients were randomly allocated into three equal groups of thirty patients each.
The results of our study found that:
•There were no statistically significant differences between the three studied groups as regard to age, sex, type of operation or ASA class.
•There was better patient’s response to spinal needle in ketamine /midazolam group than in propofol/fentanyl group.
•Ketamine /midazolam combination provided mild sedation, which was better to avoid complications of spinal anesthesia than propofol/fentanyl combination which provided moderate sedation.
•There was no statistically significant difference between the three studied groups as regard heart rate.
•Ketamine /midazolam combination provided more hemodynamic stability as regard SBP, DBP, MAP than propofol/fentanyl combination.
•There was no statistically significant difference between the three studied groups as regard SpO2.
•There were hallucinations in ketamine/midazolam group and transient apnea and only one case had airway obstruction in propofol/fentanyl group.
Through this study, we concluded that:
Ketamine /midazolam combination in dose of 0.025 mg / kg midazolam and ketamine 0.5 mg / kg provided adequate sedation to decrease patient’s discomfort during establishment of spinal anesthesia and provided more hemodynamic stability when compared with propofol/fentanyl combination in dose of 0.5 mg / kg propofol and 0.5µg / kg fentanyl.
Recommendations :
Through this study and our findings we can recommend use of ketamine /midazolam in dose of 0.025 mg / kg midazolam and ketamine 0.5 mg / kg, but we encourage further studies that conducted blindly and involving larger sample size of different ASA classifications and different doses of propofol and fentanyl to detect the dose that provide adequate sedation and better response to spinal needle to decrease the patient’s discomfort during establishment of spinal anesthesia.