Small Dose Of Midazolam Research Articles

Differentiating early clinical features of Panayiotopoulos syndrome from acute encephalopathy

BackgroundPanayiotopoulos syndrome (PS) is a common benign epilepsy in childhood, characterized by predominantly autonomic symptoms such as emesis, pallor, and seizures, which are often prolonged. In an emergency room (ER), particularly when unconsciousness is prolonged, differentiating PS from acute encephalopathy is challenging. In this study, we aimed to elucidate the differences in clinical features of patients with PS and acute encephalopathy who visited our ER. MethodsWe retrospectively reviewed 18 patients who were transferred to our ER because of status epilepticus later diagnosed as PS, and 30 patients with acute encephalopathy, between July 2012 and July 2017. We compared patient demographics, clinical characteristics, and treatment. ResultsMost patients (90%) with acute encephalopathy had convulsive seizures of greater than or equal to 15 min, whereas only three patients (17%) with PS had convulsive seizures of greater than or equal to 15 min (P < 0.001). In addition, seizures were treatable in all patients with PS with a small dose of midazolam (0.1 mg/kg), but all patients with acute encephalopathy required midazolam at 0.3 mg/kg or more (P < 0.001). More patients with PS had autonomic symptoms compared to those with acute encephalopathy (e.g., vomiting [78% vs. 3%, P < 0.001]). Non-convulsive status epilepticus was observed in 22% of PS patients, but not in any acute encephalopathy patients. In contrast, fever was observed in all patients with acute encephalopathy (100%), but less frequently in those with PS (11%, P < 0.001). ConclusionPS was characterized by 1) convulsive seizures shorter than 15 min, 2) seizures treatable with small doses of midazolam, and 3) autonomic symptoms. PS could be differentiated from acute encephalopathy in the early stages of the syndrome.

The anesthetic effects of small dose of midazolam or ketamine used for intemperants′ endoscopy

Objective To explore the safe and effective intravenous anesthetic regimen for intemperants′ painless endoscopy. Methods 120 cases of intemperants, aged 25-65 years old, ASA grade Ⅰ or Ⅱ , were randomly divided into 3 groups (n=40): sulfentanyl group (group S), midazolam and sulfentanyl group(group MS), ketamine and sulfentanyl group (group KS). Group S were intravenous injected with sufentanil 0.1 μg/kg, propofol 1-2 mg/kg, etomidate 0.1 mg/kg. Group MS and group KS were additional intravenous injected with midazolam 0.01 mg/kg and ketamine 0.1 mg/kg on the basis of Group S respectively. The occurrence of hypoxia, cough, body movement and blood pressure were recorded, the use of vasoactive drugs and the recovery time were also recorded. Results There are no statistical significant difference of age, gender, and testing time among the three groups (P>0.05). Compared with the group S, the total dose of propofol, the incidence of hypoxemia and hypotension, the incidence of body movement and cough reaction in group MS and group KS were all lower (P 0.05). Conclusions Small doses of midazolam or ketamine combined with sulfentanyl, propofol and etomidate are safe and effective in the process of anesthesia during endoscopic diagnosis and treatment of intemperants. Key words: Midazolam/AD; Ketamine/AD; Sufentanil/AD; Gastroscopy; Anesthesia; Alcoholics

A comparison of the use of propofol alone and propofol with midazolam for pediatric magnetic resonance imaging sedation \u2013 a retrospective cohort study

BackgroundPediatric MRI sedation performed by a variety of specialists such as sedationists and anesthesiologists commonly uses propofol, which has similar effects to an ideal sedative agent for maintaining deep sedation. However, when propofol is used, adverse airway events are relatively more common than when using other sedative agents. The concomitant administration of midazolam and propofol can reduce the dose of propofol needed for adequate sedation and might also reduce the frequency of airway obstruction without affecting the patient’s recovery profile.MethodsWe reviewed the our hospital records of all pediatric MRI sedation patients aged 3 to 16 years who were sedated with either propofol alone or propofol with midazolam between December 2013 and June 2016.ResultsEight hundred ninety-seven pediatric MRI sedation patients were included (n = 897). The frequency of airway intervention was 25/356 (7.0%) in Group P and 15/541 (2.8%) in Group PM (difference in proportions: 4.2%; 95% CI: 1.4–7.6%; p = 0.002). The mean (SD) time to awake was longer in Group PM compared to Group P [21.2 (5.6) minutes vs. 23.0 (7.1) minutes; mean difference, 1.8 min; 95% CI, 0.9–2.9; p < 0.001]. The mean (SD) time to discharge was longer in Group PM compared to Group P [34.5 (6.9) minutes vs. 38.6 (9.4) minutes; mean difference, 4.0 min; 95% CI, 3.0–5.1; p < 0.001].ConclusionsThe administration of a small dose of midazolam during pediatric MRI sedation using propofol can reduce the frequency of airway complications without prolonging the clinically significant recovery profile.

Patient satisfaction after endoscopic submucosal dissection under propofol-based sedation: a small premedication makes all the difference.

Ideal sedation for endoscopic submucosal dissection (ESD) aims to satisfy both the endoscopist and patient. However, previous studies show that a satisfactory procedure for the endoscopist does not equal higher patient satisfaction. This study attempted to find a sedation protocol that is able to increase patient satisfaction during propofol-based sedation by adding low-dose midazolam as premedication. Seventy-two adult patients were randomly allocated to receive either 0.02mg/kg midazolam (Midazolam Group) or placebo (Control Group) as premedication before ESD. Sedation was done by targeting Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale of 3 or 4 with continuous propofol infusion and bolus doses of fentanyl. Satisfaction scores of the endoscopists and patients, and whether the patient was willing to receive the same sedation method in the future was assessed. Interim analysis was done after enrollment of 50% of patients. This study was prematurely terminated when interim analysis showed that patients willing to receive the same sedation method in the future were significantly lower in the Control Group compared to the Midazolam Group (P=0.001). There was no difference in sedation time, procedure and recovery time, drug requirements and adverse events between the two groups. Endoscopist and overall patient satisfaction scores, patient pain scores and degree of recall were also similar between groups. A small dose of midazolam given as premedication before propofol-based sedation is able to reduce patient reluctance to repeat the same procedure in the future, without affecting procedural performance, recovery time or endoscopist satisfaction.

Manual versus target-controlled infusion of balanced propofol during diagnostic colonoscopy: A prospective randomized controlled trial

There is an increasing interest in balanced propofol sedation (BPS) for colonoscopy in outpatient settings. Propofol is a potent anesthetic agent for this purpose and has a narrow therapeutic range, which increases a risk of cardiovascular and respiratory complications in case of improper administration. The aim of this study was to compare patients’ safety and comfort of endoscopists in two methods of BPS targeting deep sedation – propofol target-controlled infusion (TCI) and manual intravenous titration technique (MT) – during colonoscopy. This prospective randomized controlled trial included 90 patients (class I or II of the American Society of Anesthesiologists) deeply sedated with propofol, coadministered with small doses of midazolam and fentanyl. Propofol was given by MT technique (45 patients) or by TCI (45 patients). The following adverse effects were recorded: hypotension, hypertension, bradycardia, tachycardia, hypoxemia, bradypnea, apnea, hiccupping, and coughing, as well as endoscopist’s comfort during colonoscopy by means of a questionnaire. The MT group compared to the TCI group had a lower mean arterial pressure in the 10th minute after the beginning (p = 0.017), and at the end of colonoscopy (p = 0.006), higher oxygen saturation in the fifth minute (p = 0.033), and in the 15th minute (p = 0.008) after the beginning of colonoscopy, and lower heart rate at the beginning of the procedure (p = 0.001). There were no statistically significant differences in adverse events. Endoscopist’s comfort during colonoscopy was high 95.6% in the TCI group vs. 88.9% in the MT group (p = 0.069). MT is clinically as stable as TCI of propofol for deep sedation during colonoscopy, and endoscopists experienced the same comfort during colonoscopy in both groups. Thus, both combinations are suitable for deep sedation during diagnostic colonoscopy.

Effect of low dose midazolam on maternal cognition function after cesarean section

Objective To explore the effect of low dose midazolam on maternal cognition function after cesarean section. Methods According to the digital table,60 women with cesarean section operation, who graded Ⅰ to Ⅱ according to America anesthesiologists(ASA), were randomly divided into the control group and observation group,30 cases in each group. The control group was given intravenous injection of 0.9% sodium chloride injection 5m L after the fetal removed, and the observation group was given small dose of midazolam intravenous injection(0.03mg/kg,diluted to 5mL). The bad memories of the maternal operation process of the two groups were observed after the operaion. Results In the control group,0 case was completely forgotten, the completely forgetting rate was 0.0%;29 cases in the observation group were completely forgotten, the completely forgetting rate was 96.7%. The completely forgetting rate of the two groups had significant difference (χ2= 19.73,P<0.01). Conclusion The small dose of midazolam can effectively eliminate the mothers during anesthesia and operation in the bad memories. Key words: Midazolam; Cesarean section; Cognitive

Dexmedetomidine Sedation With and Without Midazolam for Third Molar Surgery

Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.

Combined use of fascia iliaca block, subarachnoid block and dexmedetomidine sedation for patients having fractured femur surgery

To the Editor: Anesthesia for the patient with a fractured hip is frequently encountered and is often very challenging due to advanced age, cardiac and respiratory co-morbidities and dementia/delirium. No guidelines exist as to the best method of anesthesia for hip fracture surgery, however there is general agreement that avoiding polypharmacy, utilizing regional and neuraxial anesthesia and avoiding excessively deep anesthesia is likely optimal. For patients requiring fixation of femoral neck fractures, we present the novel anaesthetic management of dexmedetomidine (DEX) sedation, fascia iliaca regional block (FIB) and subarachnoid block (SAB). Patient characteristics, surgical procedure and anesthetic conduct are presented in Table 1. In the operating theatre a DEX loading dose averaging 0.85 mcg/kg (range 1.3–0.3 mcg/kg) was administered over 10 min. As DEX has few amnestic properties, a small dose of midazolam was also administered. Concurrently, a FIB was carried out by the classic 2-pop technique using a 16 gauge Touhy needle and 0.5 % ropivicaine. DEX was converted to a maintenance infusion averaging 0.85 mcg/kg/h (range 1–0.7 mcg/kg/h) and adjusted to optimize sedation and minimize side effects. The FIB was given 15 min to take effect, and SAB was carried out in the lateral position with the fractured side up. The administration of cardiovascular drugs was not required in three of four patients, and no airway obstruction occurred. The DEX infusion was decreased based on trends of heart rate and blood pressure, and discontinued once closure of fascia had begun. SAB may be preferred over general anesthesia as it is associated with reductions in early mortality, postoperative confusion, myocardial infarctions, pneumonia, deep vein thrombosis, fatal pulmonary embolism and postoperative hypoxia [1]. In non-cardiac surgery DEX is associated with a trend to improved cardiac outcomes and improved allcause mortality, while decreasing non-fatal myocardial infarctions, and myocardial ischemia—a2-receptor agonists attenuate the stress response and may prevent cardiac complications [2]. Hip fracture patients often suffer from delirium and dementia—up to 50 % of patients with hip fractures have delirium accompanying their acute orthopaedic injury [3]. Interventions to decrease delirium include minimizing the use of narcotics and benzodiazepines, effective pain management, use of regional and neuraxial anesthesia, and maintaining a lighter plane of anesthesia [3]. DEX produces sedation and analgesia by acting both peripherally and centrally, is purported to have a role in neuroprotection and improves effectiveness of SAB [4]. FIB is effective in this patient population as it decreases the amount of medication needed for SAB, is performed quickly and easily in the supine position and does not rely on optimal coagulation status. In these patients FIB can be utilized as the main anaesthetic for positioning the patient for SAB, is more efficacious than IV opioids in facilitating the lateral position for SAB and aids postoperative pain control [5]. We utilize 0.5 % ropivacaine in a large volume without complication to allow a relatively quick onset for positioning while maintaining a longer post-operative duration. I. L. Rapchuk (&) P. Glover Department of Anaesthesia, Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, 627 Rode Road, Chermside, QLD 4032, Australia e-mail: ivan_rapchuk@health.qld.gov.au

The cardiovascular effects of midazolam co-induction to propofol for induction in aged patients

BackgroundThe aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients.MethodsEighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation.ResultsCompared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups.ConclusionsCo-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.

The Effect of Remifentanil, Alfentanil, and Fentanyl on the Hemodynamic Changes, Analgesia, and Sedation during Retrobulbar Block in Cataract Surgery

Background: This study was designed to compare the effects of remifentanil, alfentanil, and fentanyl on the hemodynamic changes, sedation, and analgesia when administered with small doses of midazolam in patients undergoing a retrobulbar block for cataract surgery. Methods: Sixty patients scheduled for cataract surgery were divided into 4 groups (n = 15 for each group). Firstly, group C received 5 ml of a normal saline solution, 3 min before a retrobulbar block. Next, group R received remifentanil 0.3μg/kg. Furthermore, group A received a 4.5μg/kg dose of alfentanil, 90 s before a retrobulbar block, and group F received fentanyl 0.6μg/kg, 210 s before a retrobulbar block. All solutions were mixed with normal saline to a 5 ml volume. In group R, A, and F, midazolam (0.5 mg for patients over the age of 65 years; 1.0 mg in patients under the age of 65 years) was injected 3 min before the retrobulbar block. Results: The systolic blood pressure in patients significantly increased at 1 or 2 minutes after a retrobulbar block in group C and at 1 minute in group F. For group R, the systolic blood pressure decreased significantly at 3, 4, 5, and 10 minutes, and at 2, 3, 4, 5, and 10 minute in group A. The mean OAA/S scale during a retrobulbar block significantly declined in groups R and A. The VAS score for pain was significantly lower in groups R and A, whereas the VAS anxiety index was significantly lower in groups R, A, F compared to group C (P＜0.05). Conclusions: We found that the combination of remifentanil or alfentanil with midazolam showed better hemodynamic stability, sedative, and analgesic effects compared to fentanyl with midazolam in the retrobulbar block for cataract surgery. (Korean J Anesthesiol 2007; 53: 441~7)

Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist

Background There is increasing interest in the use of propofol, an ultrashort-acting hypnotic agent, for sedation during endoscopic examinations. A protocol was developed for administration of propofol, combined with small doses of midazolam and meperidine, for endoscopic sedation under the direction of a gastroenterologist. Initial experience with using this protocol is described. Methods A total of 819 consecutive endoscopic examinations under sedation with propofol, midazolam, and meperidine (or fentanyl), in adherence with the sedation protocol, were reviewed retrospectively. Results There were 638 colonoscopies and 181 EGDs; 89% of patients were classified as American Society of Anesthesiologists (ASA) class I or II. Mean dosages of medications were: propofol 63 (33.5) mg, meperidine 48 (7.2) mg, and midazolam 1 (0.12) mg. The dose of propofol was inversely correlated with age and ASA class, and positively correlated with patient weight and duration of examination. Hypotension (>20 mm Hg decline in either systolic or diastolic blood pressure) developed in 218 (27%) patients, and hypoxemia (oxygen saturation <90%) developed in 75 (9%). All episodes of hypotension and hypoxemia were transient, and no patient required administration of a pharmacologic antagonist or assisted ventilation. The average time for recovery after colonoscopy and after EGD was, respectively, 25 minutes and 28 minutes. All EGDs and 98% of colonoscopies were completed successfully. Conclusions On the basis of this initial experience, it is believed that propofol, potentiated by small doses of midazolam and meperidine, can be safely and effectively administered under the direction of a gastroenterologist. Additional research will be necessary to determine whether propofol is superior to the current methods of sedation.

Evaluation of LMA Insertion with Sevoflurane 8% and N2O after Midazolam Administration

Background: Sevoflurane is characterized by the lack of an unpleasant odorairway irritation and its low blood/gas partition coefficient (0.68), which provides rapid and smooth induction. Inhaled induction with sevoflurane is commonly used in pediare patients, but not in adult patients. This study was designed d investigate the time to completion of LMA insertion and end-irlal sevoflurane concentration during induction with sevoflurane 8%and N0 50%, after midazolam administration, in adults. Methods: Twenty eight patients, aged 20-60 years, were administered intravenous midazolam 30g/kg and after one minute, sevoflurane 8% and NO 50% were inhaled with tidal-volume breathing. One minute afu loss of consciousness, jaw thrust and mouth opening were checked and an LMA was inserted. The end-rial concentration of sevoflurane, and the times to loss of consciousness and completion of insertion were recorded. The man arterial pressure and heart rate were also recorded. Results: From initiation of sevoflurane and NO inhalation, it took 48 14 seconds until loss of consciousness, and 143 19 seconds until the completion of LMA insertion. The end-tidh sevoflurane concentration was 4.1 0.6% at loss of consciousness, 5.0 0.7% at one min after loss of consciousness, and 4.1 0.5% after LMA insertion. In all patients LMA insertion was successful and satisfactory. After LMA insertion compared to baseline, the mean arterial pressure was reduced and the heart rate increased. Conclusions: After small-dose of midazolam, inhaled induction with sevoflmne 8% and N0 50% allowed successful and satisfactory LMA insertion in adults.

Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia

We investigated the effect of a small dose of midazolam, ketamine, droperidol or lidocaine on the propofol dose required for hypnosis during induction of general anaesthesia. These drugs were randomly administered to 100 patients about to undergo scheduled surgery. Propofol was then infused at a rate of 250 microg kg-1 min-1 and the hypnotic dose to produce hypnosis was evaluated. Midazolam (20 microg kg-1) and droperidol (20 microg kg-1) significantly reduced the mean hypnotic dose of propofol (mean) S.D.) compared with the placebo (43.7 +/- 17.8 mg, 61.9 +/- 10.6 mg and 72.5 +/- 27.7 mg after pretreatment with midazolam, droperidol and placebo, respectively), whereas ketamine (0.1 mg kg-1) and lidocaine (1 mg kg-1) did not significantly affect the hypnotic dose of propofol (63. 1 +/- 25.6 mg and 65.1 +/- 24.8 mg, respectively). Only midazolam when compared with saline administration, (176 +/- 66 s and 298 +/- 126 s, respectively), shortened the time to achieve hypnosis. The changes in blood pressure (non-invasive) and heart rate were not significantly different in all groups during the induction of anaesthesia and oro-tracheal intubation. These results raise the possibility that new combinations of central nervous system drugs, such as droperidol and propofol, have a potential to reduce the dose of intravenous anaesthetics, including propofol, that produce hypnosis without significant adverse effects.

The changing role of monitored anesthesia care in the ambulatory setting.

The changing role of monitored anesthesia care in the ambulatory setting.

Small Doses of Midazolam Do Not Depress the Ventilatory Responses to Progressively Induced Hypoxia

Small Doses of Midazolam Do Not Depress the Ventilatory Responses to Progressively Induced Hypoxia

The effects of low-dose midazolam for induction of high-dose fentanyl anesthesia for coronary artery bypass graft.

A small dose of midazolam 0.06 mg/kg or diazepam 0.15 mg/kg was used for induction of high-dose fentanyl (50 μg/kg) anesthesia in patients undergoing coronary artery bypass grafting operation. Hemodynamic variables were measured 5 min after the injection of midazolam or diazepam, after the end of the fentanyl infusion, and following endotracheal intubation. Midazolam and diazepam caused a slight but significant decrease in mean arterial pressure (-9.8%) and -11.8%), respectively) and a further significant depression was observed in the diazepam group but not in the midazolam group after fentanyl. Although the cardiac index was maintained in patients who received madazolam, a significant decrease was observed in the diazepam group (-28.5%) after administration of fentanyl. Heart rate was decreased in the diazepam group but not in the midazolam group. Therefore, a small dose of midazolam may be a suitable induction agent for high-dose fentanyl anesthesia in patients with coronary artery disease.