Abstract
Midazolam, despite of being the commonest benzodiazepine used in anaesthesia and perioperative care, is a relatively newer addition to the list of adjuvant used in subarachnoid block. Midazolam causes spinally mediated analgesia and the segmental analgesia produced by intrathecal midazolam is mediated by the benzodiazepine-GABA receptor complex. Initial animal studies questioned the safety of intrathecal midazolam in terms of possible neurotoxicity. However subsequent clinical studies also failed to show any neurotoxicity of high dose midazolam even on long-term use. Addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without any significant side effects. Clinical studies also reported its safety and efficacy in pregnant women, but some studies also reported mild sedation with intrathecal midazolam. It is also reported to decrease the incidence of PONV. Intrathecal midazolam does not have any clinically significant effect on perioperative hemodynamics.
Highlights
Midazolam, synthesized by Walsar and colleagues in 1976, is the first clinically used water soluble benzodiazepine [1]
The remaining laminae of the spinal gray matter showed much lower levels of labeling. These results show a high concentration of GABA, GABA receptors, and benzodiazepine receptors in lamina II of the dorsal horn of the human spinal cord and suggest a possible role for GABA in spinal sensory functions
In 1996, Goodchild et al [8] reported that intrathecal midazolam causes antinociception by endogenous neurotransmitters acting at spinal cord delta opioid receptors and nociceptive effect has been suppressed or blocked by the delta selective opioid antagonist naltrindole suggesting an additional pathway of action, namely, via the delta-opioid receptors
Summary
Midazolam, synthesized by Walsar and colleagues in 1976, is the first clinically used water soluble benzodiazepine [1]. It is the first benzodiazepine that was produced primarily for use in anaesthesia [2]
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