Anxiolytic Effects Of Midazolam Research Articles

The Anxiolytic Effect of Midazolam in Third Molar Extraction: A Systematic Review

PurposeTo assess the efficacy of midazolam for anxiety control in third molar extraction surgery.MethodsElectronic retrievals were conducted in Medline (via PubMed, 1950-2013.12), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), Embase (via OVID 1974-2013.12), and the System for Information on Grey Literature in Europe (SIGLE). The bibliographies of relevant clinical trials were also checked. Randomized controlled trials satisfying the inclusion criteria were evaluated, with data extraction done independently by two well-trained investigators. Disagreements were resolved by discussion or by consultation with a third member of the review team.ResultsTen studies were included, but meta-analysis could not be conducted because of the significant differences among articles. All but one article demonstrated that midazolam could relieve anxiety. One article demonstrated that propofol offered superior anxiolysis, with more rapid recovery than with midazolam. Compared with lorazepam and diazepam, midazolam did not distinctly dominate in its sedative effect, but was safer. Two articles used midazolam in multidrug intravenous sedation and proved it to be more effective than midazolam alone.ConclusionIt was found, by comparison and analysis, that midazolam might be effective for use for anxiety control during third molar extraction and can be safely administered by a dedicated staff member. It can also be used with other drugs to obtain better sedative effects, but the patient’s respiratory function must be monitored closely, because multidrug sedation is also more risky.

Sedative and anxiolytic effects of midazolam and triclofos oral premedication in children undergoing elective surgery: A comparison

Sedative and anxiolytic effects of midazolam and triclofos oral premedication in children undergoing elective surgery: A comparison

The anxiolytic effects of midazolam during anticipation to pain revealed using fMRI

Background and Purpose Functional neuroimaging can distinguish components of the pain experience associated with anticipation to pain from those associated with the experience of pain itself. Anticipation to pain is thought to increase the suffering of chronic pain patients. Inappropriate anxiety, of which anticipation is a component, is also a cause of disability. We present a pharmacological functional magnetic resonance imaging (fMRI) study in which we investigate the selective modulation by midazolam of brain activity associated with anticipation to pain compared to pain itself. Methods Eight right-handed male volunteers underwent fMRI combined with a thermal pain conditioning paradigm and midazolam (30 μg/kg) or saline administration on different occasions, with order randomized across volunteers. Volunteers learned to associate a colored light with either painful, hot stimulation or nonpainful, warm stimulation to the back of the left hand. Results Comparison of the period during thermal stimulation (pain−warm) revealed a network of brain activity commonly associated with noxious stimulation, including activities in the anterior cingulate cortex (ACC), the bilateral insular cortices (anterior and posterior), the thalamus, S1, the motor cortex, the brainstem, the prefrontal cortex and the cerebellum. Comparison of the periods preceding thermal stimulation (anticipation to pain−anticipation to warm) revealed activity principally in the ACC, the contralateral anterior insular cortex and the ipsilateral S2/posterior insula. Detected by a region-of-interest analysis, midazolam reduced the activity associated specifically with anticipation to pain while controlling for anticipation to warm. This was most significant in the contralateral anterior insula (P<.05). There were no significant drug effects on the activity associated with pain itself. Conclusion In identifying a pharmacological effect on activity preceding but not during pain, we have successfully demonstrated an fMRI assay that can be used to study the action of anxiolytic agents in a relatively small cohort of humans.

The anxiolytic effects of midazolam during anticipation to pain revealed using fMRI

Functional neuroimaging can distinguish components of the pain experience associated with anticipation to pain from those associated with the experience of pain itself. Anticipation to pain is thought to increase the suffering of chronic pain patients. Inappropriate anxiety, of which anticipation is a component, is also a cause of disability. We present a pharmacological functional magnetic resonance imaging (fMRI) study in which we investigate the selective modulation by midazolam of brain activity associated with anticipation to pain compared to pain itself. Eight right-handed male volunteers underwent fMRI combined with a thermal pain conditioning paradigm and midazolam (30 mug/kg) or saline administration on different occasions, with order randomized across volunteers. Volunteers learned to associate a colored light with either painful, hot stimulation or nonpainful, warm stimulation to the back of the left hand. Comparison of the period during thermal stimulation (pain-warm) revealed a network of brain activity commonly associated with noxious stimulation, including activities in the anterior cingulate cortex (ACC), the bilateral insular cortices (anterior and posterior), the thalamus, S1, the motor cortex, the brainstem, the prefrontal cortex and the cerebellum. Comparison of the periods preceding thermal stimulation (anticipation to pain-anticipation to warm) revealed activity principally in the ACC, the contralateral anterior insular cortex and the ipsilateral S2/posterior insula. Detected by a region-of-interest analysis, midazolam reduced the activity associated specifically with anticipation to pain while controlling for anticipation to warm. This was most significant in the contralateral anterior insula (P<.05). There were no significant drug effects on the activity associated with pain itself. In identifying a pharmacological effect on activity preceding but not during pain, we have successfully demonstrated an fMRI assay that can be used to study the action of anxiolytic agents in a relatively small cohort of humans.

A comparative study with two types of elevated plus-maze (transparent vs. opaque walls) on the anxiolytic effects of midazolam, one-trial tolerance and fear-induced analgesia

The phenomenon known as one-trial tolerance (OTT) to the anxiolytic effects of benzodiazepines observed in rats submitted to the elevated plus-maze test (EPM) is considered to be due to the emergence of phobic states across the test/retest sessions. Antinociception is a usual component of the defense reaction. Until now, no study has examined antinociception and OTT together in freely behaving rats in the EPM. This work is a new approach looking at the sensorimotor gatings underlying OTT through the examination of the changes in reactivity to noxious stimuli during OTT development. We used the tail-flick test to assess the reactivity of rats to noxious stimulus during the effects of midazolam in test/retest sessions using two types of EPM, one with opaque (standard EPM) and another one with transparent walls (modified EPM). The authors had previously shown that this modified test caused an overall stressful situation more related to anxiety while the standard test coursed with a mixture of anxiety and high fear levels. In both plus mazes, the study was conducted in two experiments: (i) midazolam before the first trial, and (ii) midazolam before the second trial. In each experimental condition the effects of midazolam were tested under two doses (0.5 and 1.0 mg/kg) against a control group that received injections of saline. The anxiolytic effects of midazolam were more pronounced in animals tested in the modified EPM than in the standard EPM. Stressful stimuli present in both types of maze were able to elicit one-trial tolerance to midazolam on re-exposure. However, anxiolytic-insensitive behaviors in the first and the reduction in exploratory activity in the second trial are more pronounced in the standard EPM indicating that this test is more prone to transfer fear-related states across trials than the modified maze test. Antinociception is not present upon the re-exposure of rats to the EPM. These findings show that animals tested in the modified EPM showed higher sensitivity to the anxiolytic effects of midazolam than the standard EPM. Antinociception was not a concomitant of the shift in the emotional state present in the retest sessions of the EPM. These results are in agreement with the premises that repeated stressful experience leads to anxiolytic-insensitive fear state different from anxiety.

Preoperative intravenous midazolam: benefits beyond anxiolysis

Study objective To evaluate the effect of midazolam on the global perioperative experience, including patient satisfaction, postoperative nausea and vomiting, postoperative pain, and perioperative anxiety and amnesia. Design Prospective, randomized, placebo-controlled study. Setting Ambulatory surgical center affiliated with a tertiary-care hospital. Patients 88 ASA physical status I, II, and III patients scheduled for outpatient surgery. Interventions Patients were randomized into two groups to receive either 0.04 mg/kg of midazolam or placebo intravenously (IV) 20 minutes preoperatively. Measurements Perioperative measurements included blood pressure, heart rate, and oxygen saturation and the patient's level of anxiety; type of anesthetic administered; the anesthesiologist's guess at the treatment arm; perioperative dosages of fentanyl, morphine, and ondansetron; recovery room length of stay; frequency of nausea and vomiting, and level of postoperative pain in the 24 hours after surgery; the patient's overall satisfaction with the anesthetic, and whether the patient would recommend the premedication to a friend. Main results Patient demographics, type of surgery/anesthesia, vital signs, case duration, recovery duration, and postoperative pain were all similar between the midazolam and placebo groups. As expected, IV midazolam was an effective anxiolytic. There was no evidence of retrograde amnesia. Fewer patients in the midazolam group suffered from postoperative nausea than did those in the placebo group (25% vs. 50%; p = 0.03), despite receiving similar perioperative antiemetic and opioid administration. Similarly, fewer patients in the midazolam group experienced postoperative vomiting than placebo group patients (8% vs. 21%), although this difference did not reach statistical significance. Only 42% of patients in the placebo group would recommend their premedication to a friend, compared with 85% of patients in the midazolam group ( p < 0.001). Conclusions In addition to the known anxiolytic effects of midazolam, midazolam premedication is an effective way to reduce the frequency of postoperative nausea, and perhaps vomiting, and increase patient satisfaction.

Tolerance to the anxiolytic effects of midazolam, clonazepam, and diazepam.

Tolerance to the anxiolytic effects of midazolam, clonazepam, and diazepam.

The effect of oral midazolam on anxiety of preschool children during laceration repair

Preschool age children often experience marked anxiety and physical pain during laceration repair. Locally infiltrated anesthetics or topical tetracaine, adrenaline, and cocaine (TAC) usually control the physical pain but have little or no effect on anxiety. Midazolam is a short-acting benzodiazepine with anxiolytic, hypnotic, and antegrade amnestic effects. In a double-blind, randomized clinical trial, we evaluated the efficacy of midazolam in alleviating anxiety during laceration repair in children less than 6 years old. On admission to the emergency department, anxiety level was determined on a scale of 1 to 4 based on a predetermined behavior criteria. Patients with high anxiety level (3 or 4) received a single oral dose of either midazolam (0.2 mg/kg) or placebo. The anxiolytic effect of midazolam was considered adequate if the anxiety level decreased two or more points (from 4 to less than or equal to 2 or from 3 to 1) during laceration repair. In the midazolam group (30), 70% of the children had a two-point or more decrease in anxiety level compared with 12% in the placebo group (25) (P less than .0001). No respiratory depression or other complications were noted in the midazolam group. We conclude that a single oral dose of midazolam (0.2 mg/kg) is a safe and effective treatment for alleviating anxiety in children less than 6 years old during laceration repair in the ED.

COMPARISON OF MIDAZOLAM, DIAZEPAM AND PLACEBO I.M. AS PREMEDICATION FOR REGIONAL ANAESTHESIA: A Randomized Double-Blind Study

In a randomized double-blind study, midazolam 0.1 mg kg-1 i.m. was compared with diazepam 0.2 mg kg-1 and placebo as premedication for patients undergoing urological interventions under spinal anaesthesia. The sedative and anxiolytic effects of midazolam were evident 5-10 min after administration, and were maximum between 30 and 90 min. After this, rapid recovery was observed. More than 90% of the patients receiving midazolam were totally or partially amnesic for the procedures in the induction room and the operation theatre. Amnesia was not seen in the patients receiving diazepam or placebo and, in contrast to midazolam, diazepam had almost no sleep-inducing effect. In a few patients, the depth of sleep achieved with midazolam 0.1 mg kg-1 was such that co-operation was impaired.