Midazolam For Sedation Research Articles

Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

BackgroundPostictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge.MethodsThis retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records.ResultsOf all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade.DiscussionIn this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.

The Use of Inferior Vena Cava Ultrasonography to Assess Fluid Overload in Acute Lung Oedema in Severe Preeclampsia Patient

Introduction: Accurate evaluation of volume status is essential for appropriate therapy because inadequate assessment of volume status can result in unnecessary administration of therapy, which can increase mortality. This study aimed to describe the use of inferior vena cava ultrasound in assessing fluid overload in severe preeclampsia patients.&#x0D; Case presentation: We report a 23-year-old female patient with a diagnosis of acute pulmonary oedema, and severe preeclampsia at G1P0A0 40 weeks gestation with complaints of shortness of breath. On physical examination, the patient appeared short of breath with RR 32 x/minute, fine wet crackles in both lung fields, SpO2 92% with NRM 15 L/m, HR 160 x/minute, lifting strength, CRT &lt; 2 seconds, blood pressure 160/120 mmHg. This patient underwent emergency termination of pregnancy by C-section under general anesthesia rapid sequence induction followed by intensive care in the ICU. Management in the ICU this patient was given mechanical ventilation, midazolam sedation 0.05 mg/kg, analgesic morphine 10 mcg/kg, fluid restriction with a fluid balance target of (-)1000 ml/24 hours and given furosemide 10 mg/hour to reduce fluid overload so that fluid in the lungs can be reduced. Evaluation of fluid overload by IVC ultrasound.&#x0D; Conclusion: Acute pulmonary edema requires proper management to get a good outcome. Measurement of the diameter of the inferior vena cava (IVC) can also be used to assess fluid volume status. Lack of volume is assessed with an IVC diameter of &lt;1.5 cm, while an IVC diameter of &gt;2.5 cm indicates volume overload.

Oral midazolam vs. intranasal dexmedetomidine plus oral midazolam for sedation of pediatric outpatients: a double-blinded randomized controlled trial

BackgroundModerate to deep sedation is required for dental treatment of children with dental anxiety. Midazolam is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric sedation.ObjectiveThe aim of this trial was to compare the sedative efficacy of oral midazolam alone with that of intranasal dexmedetomidine plus oral midazolam during dental treatment of children with dental anxiety.DesignIn total, 83 children (aged 3–12 years) scheduled to undergo dental sedation were randomized to receive oral midazolam (0.5 mg/kg) and intranasal placebo, or oral midazolam (0.5 mg/kg) plus intranasal dexmedetomidine (2 µg/kg). The primary outcome was the rate of successful sedation for dental treatment. Secondary outcomes were the onset time and adverse events during and after treatment. Data analyses involved descriptive statistics and nonparametric tests.ResultsThe rate of successful sedation was significantly higher in combination group (P = 0.007), although the sedation onset time was significantly longer in combination group (17.5 ± 2.4 min) than in monotherapy group (15.7 ± 1.8) (P = 0.003). No children required medical intervention or oxygen therapy for hemodynamic disturbances, and the incidences of adverse events had no significant difference between groups (P = 0.660).ConclusionCombined treatment with oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (2 µg/kg) is more significantly effective for managing the behavior of non-cooperative children during dental treatment, compared to oral midazolam (0.5 mg/kg) alone. (Chinese Clinical Trial Registry: ChiCTR2100042300)Trial registrationChiCTR2100042300, Clinical trial first registration date: 17/01/2021.

Midazolam for procedural sedation in adults and children. Literature review

The use of medicated procedural sedation in ambulatory surgery and in intensive care units has become popular due to increased treatment options for the doctor and increased comfort for the patient. The purpose of this literature review is to highlight studies reporting the efficacy and safety of midazolam as a sedative in adults and children for procedural sedation.

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

S737 Safety and Efficacy of Diphenhydramine as an Adjunct to Midazolam and Fentanyl for Sedation in Patients Under the Age of 45 Undergoing Endoscopic Evaluation

S737 Safety and Efficacy of Diphenhydramine as an Adjunct to Midazolam and Fentanyl for Sedation in Patients Under the Age of 45 Undergoing Endoscopic Evaluation

Propofol Versus Midazolam for Sedation in Patients With Cirrhosis Undergoing Upper Endoscopy: A Single-Blind Randomized Clinical Trial

Background: Patients with hepatic cirrhosis are frequently screened for the complications of portal vein hypertension using upper endoscopy. The current study aimed to compare the efficacy and safety of midazolam and propofol for sedation in patients with cirrhosis undergoing upper endoscopy. Methods: This single-blind randomized clinical trial included 60 cirrhotic patients aged 18-80 years referred to Shahid Mohammadi hospital, Bandar Abbas, Iran from May 22, 2019, to May 21, 2020, for upper endoscopy. The age, gender, weight, and height of the patients were recorded, and they were randomized into two groups. Patients in the midazolam group (n=30) received 0.05 mg/ kg midazolam for induction which continued with a 1 µg/kg/min dose, and those in the propofol group received 1 mg/kg propofol which continued with a 25-75 µg/kg/min dose. Blood pressure, oxygen saturation (SpO2 ), respiratory rate (RR), and heart rate (HR) were measured before induction, immediately, 1, and 5 minutes after induction, and in the recovery unit. Finally, the time to reach the target sedation (Ramsay sedation scale≥5), sedation duration, and recovery time were noted as well. Results: Patients in both groups were comparable regarding age, gender, weight, and height. There were no significant differences between groups regarding hemodynamic parameters at any given time point, except for RR 1 minute after induction, which was significantly higher in the propofol group (P=0.012). Changes in HR from baseline to recovery were significant in both groups. Moreover, changes in SpO2 from baseline to recovery were only significant in the midazolam group (P&lt;0.001). The time to reach the target sedation and sedation duration were significantly lower in the propofol group (P&lt;0.001 and P=0.003, respectively); however, there was no significant difference between groups with regard to the recovery time. Grade II encephalopathy (West Haven criteria) developed in one patient in the midazolam group. Conclusion: Based on the results of the current study, although propofol was superior to midazolam for upper endoscopy in cirrhotic patients with respect to the time to reach the target sedation and sedation duration, the two drugs were rather comparable in terms of hemodynamic stability. However, hepatic encephalopathy with midazolam remains a major concern.

Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam.

To assess the sedative failure rate over different dose combinations of intranasal dexmedetomidine and oral midazolam for procedural sedation. This was a retrospective study. Four groups were established according to the initial dose of sedatives. The primary outcome was the sedative failure rate for different doses of the two-drug combination. The risk factors associated with sedation failure were analyzed. A total of 2165 patients were included in the final analysis. Of these, 394 children were classified as sedation failure after the initial dose of a combination of intranasal dexmedetomidine and oral midazolam. Although the initial doses of intranasal dexmedetomidine and oral midazolam administered to patients varied widely, no significant differences were detected in the sedation outcomes among the groups. Multivariate analysis showed that sedation history, a history of sedation failure, and echocardiography were independent risk factors for sedation failure after an initial dose of intranasal dexmedetomidine and oral midazolam. In contrast, patients undergoing lung function and MRI were more likely to be successfully sedated. A combination of low-dose intranasal dexmedetomidine and oral midazolam provides adequate sedation efficacy without any increase in side effects, especially for patients undergoing MRI or lung function examination. This is an original article about the risk factors of sedation failure with an initial dose of intranasal dexmedetomidine and oral midazolam for procedure sedation. For patients undergoing echocardiogram, it is better to choose other sedatives, while a combination of intranasal dexmedetomidine and oral midazolam is a good option for patients undergoing MRI or lung function. The selection of sedative drugs should be personalized according to different procedures.

Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study.

Objective: Colonoscopy plays an important role in the diagnosis, prognosis prediction, assessment of disease activity and severity, and treatment of inflammatory bowel disease (IBD)-related complications. However, some patients refuse to undergo colonoscopy due to perceived pain and other discomfort, their diagnosis and treatment are affected. Therefore, we conducted a prospective study to explore the efficacy and safety of midazolam combined with dezocine for sedation in IBD patients undergoing colonoscopy. Methods: 224 patients were divided into sedative-colonoscopy-group (SCG, n = 93), anesthesia-colonoscopy-group (ACG, n = 90) and ordinary-colonoscopy-group (OCG, n = 41). The vital signs (blood pressure, pulse, respiration and blood oxygen saturation), pain degree during colonoscopy, satisfaction and complication rates of the three groups were compared. Results: Before colonoscopy, there was no significant difference among the vital signs of the three groups. The vital signs of the ACG were significantly lower than those of the SEG and the OCG (p < 0.05), and the difference was not significant between the SCG and OCG during colonoscopy. The colonoscopy pain score in the SCG was lower than that in the OCG (0.79 ± 1.09 vs. 2.98 ± 1.27, p < 0.001). The satisfaction score of the SCG (9.26 ± 1.16) was not significantly different from that of the ACG (9.42 ± 1.41) but was higher than that of the OCG (6.63 ± 1.13) (p < 0.001). The total complication rate of the ACG was 45.56% (41/90), which was significantly higher than that of the SCG [20.43% (19/93)] and the OCG [19.51% (8/41)]. Colon perforation, abnormal blood pressure fluctuation and hypoxemia were significantly more common in the ACG than in the SCG and the OCG (p < 0.05). However, there was no significant difference in the incidence of complications between the SCG and OCG. Conclusion: Compared with ordinary-colonoscopy, colonoscopy performed under midazolam and dezocine sedation is more comfortable for patients, thereby increasing satisfaction and compliance. Colonoscopy that is performed under midazolam and dezocine is similar to colonoscopy that is anesthesia with propofol in terms of comfort, satisfaction and compliance and similar to ordinary-colonoscopy in terms of safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine for digestive endoscopy is worthy of clinical promotion.

Effectiveness and safety of dentist-led conscious sedation using fentanyl with midazolam in dentistry: a five-year retrospective service evaluation.

Background Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct, but this advanced sedation technique requires additional training. Studies reporting on the safety and effectiveness of dentist-led conscious sedation using fentanyl and midazolam are lacking.Aims To review the indication of use, safety and effectiveness of fentanyl and midazolam sedation at The Royal London Dental Hospital since its introduction into the service.Method Retrospective data collection of sedation cases from October 2016 to October 2021 was carried out.Results Of the 109 cases included, the majority of patients who had fentanyl (90.8%) had a history of unsuccessful sedation with midazolam. A lower average dose of midazolam was administered when fentanyl was used; the difference was statistically significant (p <0.0001). A higher proportion of patients who had fentanyl and midazolam presented with lower Ellis scores (better operating condition) compared to midazolam-only sedation. No adverse incidents were recorded.Conclusion In this evaluation, the synergistic effects of fentanyl and midazolam resulted in enhanced sedation, anxiolysis and intraoperative conditions. This service evaluation showed some encouraging data regarding the potential safety profile and effectiveness of fentanyl in dental sedation when used by experienced clinicians; however, larger scale studies are required to validate this.

Propofol or Midazolam for sedation and early extubation following coronary artery bypass graft surgery

Objective: to evaluate the efficacy of Midazolam and Propofol for postoperative sedation and early extubation following cardiac surgery. Methodology: Randomized control trial was conducted cardiac anesthesia department of the National Institute of Cardiovascular Diseases in one year duration of 1st February 2018 to 30th January 2019. Study was conducted on ASA 3 who was selected for coronary artery bypass graft surgery. After shifting in ICU patients were divided in two groups by lottery method and study drugs propofol and midazolam were started. Both infusions were terminated after four hours and patients were assessed for extubation. Hemodynamic parameters arterial blood gases and respiratory function was assessed and recorded. Results: The mean time to awakening, time to extubation in midazolam group was 94.11±4.36 minutes, 94.47±6.11 minutes respectively and in propofol group it was 96.58±4.31 minutes, 91.91±3.94 minutes respectively. Difference was statistically significant. Conclusion: Results of our study reveal that there was no difference in both drugs regarding sedation and extubation time; both drugs are safe, effective and useful in patients of coronary artery bypass graft surgery.

NITROUS OXIDE OR MIDAZOLAM TO TOOTH EXTRACTION? A SYSTEMATIC REVIEW

Aim: This systematic review aimed to evaluate the use of midazolam and nitrous oxide in conscious sedation for dental extraction procedures. Methods: A search was conducted in electronic searches Medline/PubMed, Embase, Cochrane Library, Web of Science, grey literature, and the main scientific journals in the area, following PRISMA. Booleans operators were used for the combinations of terms and the search strategy was adapted to each of the databases, (“tooth extraction” OR “molar, third” OR “tooth, impacted” OR “surgery, oral” OR “exodontics” OR “wisdom tooth” AND “nitrous oxide” OR “anesthetics, inhalation” OR “conscious sedation” OR “laughing gas” OR “moderate sedation” AND “midazolam” OR “benzodiazepines” OR “hypnotics and sedatives” OR “sedative effect”). Study Selection and Data Extraction: The inclusion criteria were parallel and crossover RCTs involving patients of any age submitted to tooth extraction at a dental office under local anesthesia. No language restrictions have been imposed until 2023. The exclusion criteria were studies involving patients submitted to extraction in the hospital setting, studies that did not measure anxiety or sedation and studies for which the full text was not available. Results: Where within the eight articles that met the eligibility criteria, no significant differences were found between the methods, in relation to sedation or anxiety. Conclusion: In conclusion, nitrous oxide and midazolam safely ensure good levels of sedation and anxiety control, being pharmacological approaches possible to be used in dental care, even in those more invasive such as, tooth extraction.

A Comparison of the Sedative Effect of Dexmedetomidine and Midazolam on Patients Undergoing Gastrointestinal Endosonography Outside the Operating Room.

Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs. This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room. This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography. Patients were randomly divided into 2 groups. The dexmedetomidine group received dexmedetomidine (1 μg/kg) for 25 minutes with propofol (0.5 mg/kg) and fentanyl (1 μg/kg) at the start of the procedure. The midazolam group received midazolam (0.03 mg/kg) with propofol (0.5 mg/kg) and fentanyl (1 μg/kg). Heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) were recorded before and 5, 10, and 15 minutes after starting the procedure. The Ramsay Sedation Scale (RSS) and the need for an additional dose of propofol were recorded during the procedure. The Numeric Pain Rating scale (Ambesh score) scores were recorded at the beginning, immediately after, and 1 hour after the procedure. Nausea and vomiting were assessed using the Visual Analogue Scale in cooperation with the patient. The dexmedetomidine group had significantly higher SpO2 and RSS scores during sedation than the midazolam group (P = 0.02). Overall, specialist satisfaction was higher in the dexmedetomidine group than in the midazolam group. There was no clinically significant difference in pain score and nausea and vomiting frequencies between the 2 groups. Dexmedetomidine is more effective than midazolam for sedation during gastrointestinal endosonography.

Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial.

The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA- groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA- group in terms of the pharyngeal observation success rate. The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA-) groups were 84.0% and 72.0%, respectively. The PA- group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0-10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA- group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

Propofol infusion for sedated upper gastrointestinal endoscopic ultrasound: a comparison of propofol alone versus propofol-fentanyl or propofol-midazolam

Background: Gastrointestinal (GI) endoscopic untrasound is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combine with midazolam or fentanyl in moderate sedation for GI endoscopy. Objectives: To observe the efficiency comparison between propofol alone and propofol/fentanyl or propofol/midazolam on sedation during upper gastrointestinal endoscopic ultrasound. Methods: In a prospective, randomized clinical study, 90 patients were assigned to group 1 (n = 30; 1 mg/kg IV propofol) group 2 (n = 30; 1 mg IV midazolam intravenous followed 1 mg/kg IV propofol) or group 3 (n = 30; 50 μg fentanyl followed 1 mg/kg IV propofol). Each patient was administered 1 mg/kg propofol for induction. All of the patients were administered an additional dose of IV propofol infusion (5 mg/kg/h). This study was performed in Hue University of Medicine and Pharmacy Hospital, between January 2020 - 2021. Total propofol consumption, time to achieve, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. Results: The average propofol consumption was 283.8 ± 113 mg in Group 1 and 230 ± 76.3 mg in Group 2 and 231.8 ± 76.3 mg in Group 3 (p &lt; 0.05). The incidence of moving motor or verbal) was lower in Group 3 (p &lt; 0.05). The physician satisfaction was higher significantly in Group 3 (p &lt; 0.05). Total propofol consumption was higher in group 1 significantly. Time to onset of sedation was significantly higher in group 1 The physician satisfaction was higher significantly in Group 3. Overall, the other results were similar in 3 groups. Conclusion: Both propofol/fentanyl and propofol/midazolam combinations provided appropriate hypnosis and analgesia during upper gastrointestinal endoscopy. However, propofol consumption was significantly lower and greater endoscopist satisfaction in group using the propofol/ fentanyl combination. Key words: sedation, upper gastrointestinal endoscopy, propofol, fentanyl, midazolam

Oral Ketamine or Nasal Midazolam for Sedation in Pediatric Upper Gastrointestinal Endoscopy

Background: There is no agreement on the route of administration and the drug of choice for providing adequate sedation for pediatric invasive procedures. Objectives: We compared the utility, safety, and sedation effects of intranasal midazolam and oral ketamine. Materials &amp; Methods: This double-blind clinical trial was performed on 100 children aged 2 to 14 years who were candidates for upper gastrointestinal (GI) endoscopy. Patients were randomly assigned to two groups: ketamine (4 mg/kg orally) and midazolam (0.1 mg/ kg intranasal). Sedation score, fear levels, children’s behavior at the time of separation from parents, and vital signs were recorded. Results: Higher systolic blood pressure was seen in children who received ketamine (P=0.012) and lower arterial oxygen saturation in the midazolam group (P=0.023). Also, the level of sedation showed no significant difference between the groups. Conclusion: Based on the results, administering oral ketamine or intranasal midazolam before endoscopy induced a similar sedation score in children. Also, both methods could be safe and non-invasive modalities for sedation.

Economic benefits of remimazolam compared to midazolam and propofol for procedural sedation in colonoscopies and bronchoscopies

Background Sedation is common practice in endoscopic procedures to suppress a patient’s level of consciousness while maintaining the cardio-respiratory function. Midazolam and propofol are the sedatives most frequently used for procedural sedation at hospitals in Scandinavia. Remimazolam is a new ultra-short-acting benzodiazepine sedative and the present analysis aimed at estimating the economic benefits of introducing remimazolam for procedural sedation in colonoscopies and bronchoscopies in hospitals in Scandinavia. Method We developed a cost model applying a micro-costing approach that comprised the cost components that are affected by differences in the efficacy of remimazolam, midazolam, and propofol, and the model estimated the cost per successful colonoscopy and bronchoscopy when using remimazolam, midazolam or propofol as sedation. A micro-costing approach was applied, and the model consisted of six stages representing the journey for patients undergoing endoscopies and was informed primarily by data from clinical studies on remimazolam. Results We found a total cost of DKK 1200 per successful colonoscopy procedure when using remimazolam, a total cost of DKK 1320 when using midazolam, and a total cost of DKK 1255 when using propofol. Hence, the incremental saving per successful colonoscopy procedure of using remimazolam was estimated to be DKK 120 compared to midazolam and DKK 55 compared to propofol. The total cost per successful bronchoscopy procedure when using remimazolam was DKK 1353 and DKK 1724 for midazolam, resulting in an incremental saving per bronchoscopy of DKK 372 when using remimazolam. Performed sensitivity analyses identified the time in recovery as the largest contributor to uncertainty in the analyses of remimazolam compared to midazolam in colonoscopies and bronchoscopies. In the comparison of remimazolam and propofol in colonoscopies, procedure time was the largest contributor to uncertainty. Conclusion We found that procedural sedation with remimazolam was associated with economically meaningful savings compared to procedural sedation with midazolam and propofol in colonoscopies and to midazolam in bronchoscopies.

A Comparative Study of Propofol Vs Midazolam for Sedation and Anti Emetic Effect in Spinal Anesthesia

A Comparative Study of Propofol Vs Midazolam for Sedation and Anti Emetic Effect in Spinal Anesthesia

Influence of Age and Sex on the Pharmacokinetics of Midazolam and the Depth of Sedation in Pediatric Patients Undergoing Minor Surgeries.

Whether age and sex influence the depth of sedation and the pharmacokinetics of midazolam is currently unknown. The influence of age and sex was investigated in 117 children (2 to 17 years) who required intravenous sedation for minor surgery (0.05 mg/kg). Plasma concentrations and sedation effects were simultaneously measured. The measured concentrations were analyzed using a two-compartment model with first-order elimination. Among the age ranges, significant differences were found (p < 0.05) between the volume of distribution (Vd) of the first compartment (V1) and that of the second (V2). With respect to sex, differences in V2 were found between age groups. At the administered dose, in patients younger than 6 years, a profound sedative effect (40-60 BIS) was observed for up to 120 min, while in older children, the effect lasted only half as long. The differences found in the Vd and bispectral index (BIS) in patients younger than 6 years compared to older patients may be due to immature CYP3A activity and body fat content; furthermore, the Vd varies with age due to changes in body composition and protein binding. Patients younger than 6 years require intravenous (IV) doses <0.05 mg/kg of midazolam for deep sedation. Dosage adjustments according to age group are suggested.

Safe sedation during diagnostic and therapeutic flexible bronchoscopy in Japan: A review of the literature.

We explored whether a combination of an opioid (fentanyl or pethidine) and midazolam could safely sedate Japanese patients undergoing bronchoscopic procedures. We searched the PubMed Medline and Igaku Chuo Zasshi (ICHUSHI) databases from 1980 to 2022 for papers on sedatives used during bronchoscopy, especially opioids (fentanyl and pethidine) and midazolam. The keywords were "bronchoscopy" and "sedation" ("kikanshikyo" and "chinsei", respectively, in Japanese). The results showed that midazolam was the preferred sedation agent during flexible bronchoscopy; with midazolam sedation is rapid, and the drug is associated with anterograde amnesia and decreased discomfort. A combination of an opioid (fentanyl or pethidine) and midazolam improved the patient tolerance and willingness to undergo a repeat procedure and also improved the working conditions for the physician. The British Thoracic Society guideline of 2013 suggested that a combination of an opioid (fentanyl or alfentanil) and midazolam should be considered to improve bronchoscopic tolerance. The American College of Chest Physicians Consensus Statement of 2011 suggested that fentanyl should be preferred; the onset of action and peak effect are rapid, and the effects are of relatively short duration. Emphasis has been placed on safety aspects, such as patient monitoring, the precautions that should be taken in patients with certain conditions, prevention and management of complications, adequate staffing, and optimal sedation and disinfection. In conclusion a combined opioid (fentanyl or pethidine) and midazolam sedation is optimal for diagnostic and therapeutic flexible bronchoscopy in Japanese patients.