Use Of Midazolam Research Articles

Use of sedative drugs at reducing the side effects of voiding cystourethrography in children.

Background:Imaging of the kidneys and urinary tract has a significant and critical role for diagnosis of genitourinary system diseases. Although technological progress goes toward less invasive approaches, some of the current methods are still invasive and annoying. Voiding cystourethrography (VCUG) is the best and most accurate method for diagnosis and grading of vesicoureteral reflux. VCUG is a distressful procedure that gives serious anxiety and pain in a large proportion of children and fear for parents; therefore, using effective sedative drugs with the least side effects is necessary and should be considered.Materials and Methods:In this review article, importance and efficacy of different drugs before catheterization VCUG be compared in the base of literature survey on EMBASE, PubMed, and Cochrane source.Results:We found that the treatment should be based on nonpharmacological and pharmacological methods; nonpharmacological treatment includes the psychological preparation before procedures as a safety precaution with little or no risk modality, as well as reassuring support. The presence of parents during painful procedures cannot alleviate children distress. Pharmacological methods include oral midazolam (0.5 mg/kg) and intranasal use (0.2 mg/kg) that had been used 10 min before the procedure can effect on anterograde amnesia and sedation without considerable effect on accuracy and grade of reflux. Nitric oxide has a shorter recovery time versus midazolam but has a potential risk for deep sedation and may interfere with the child's voiding phase.Conclusion:In summary, oral midazolam of 0.5–0.6 mg/kg or 0.2 mg/kg intranasal is acceptable drug that can be used before VCUG.

Droperidol for psychosis-induced aggression or agitation.

Droperidol for psychosis-induced aggression or agitation.

English

INTRODUCTION: Anaesthesia has made major advances in recent years. Considerable efforts have been devoted to airway management by the anesthesiologist during the past 20 years. A large number of supraglottic airway devices have been introduced recently. The original purpose was to reduce the need for more invasive methods of airway management while offering a more reliable alternative to the facemask. The laryngeal mask airway (LMA) is one such innovative device designed for airway management. One of the principal aims of anaesthesia is to counter surgically induced stress. So the anesthesiologist should be able to use a method of delivering the anaesthetic that is by itself not stress inducing3. Since the LMA is placed directly over the posterior pharynx, it avoids tracheal stimulation and hence the systemic and ocular stress response associated with tracheal intubation. AIM OF THE STUDY: The aim of the study is to observe the usefulness of Midazolam and mini-dose of Succinyl choline to facilitate the insertion of laryngeal mask airway during Propofol anesthesia in elective general surgery patients based on the following parameters. 1. Conditions during insertion of laryngeal mask airway such as jaw relaxation, ease of insertion, number of attempts for insertion, airway trauma and total dose of Propofol. 2. Patient’s response to insertion of laryngeal mark airway such as gagging, coughing, head and limb movements, laryngospasm, etc. 3. Hemodynamic parameters like mean arterial pressure, heart rate and oxygen saturation. MATERIALS AND METHODS: After obtaining institutional ethical committee clearance and the patient consent, the study was carried out on 75 patients posted for elective surgical procedures lasting less than or equal to 45 min at Madras Medical College & GGH, Chennai. Patients belonging to the age group of 18 – 50 years of both the sexes were selected. Inclusion Criteria: 1. Elective short surgical procedures lasting less than or equal to 45 min Patients of ASA physical status I and II, 2. Aged between 18 – 50 years of both sexes. Exclusion Criteria: 1. Patients with full stomach ,pregnant patient, 2. Patients posted for emergency surgery, 3. Patients with oral, peri oral pathology such as tumours, abscess or grossly enlarged tonsils. OBSERVATIONS AND RESULTS: This study was conducted on 75 patients who were divided into 3 Groups of 25 patients each. Group A - Propofol Group, Group B - Propofol with midazolam Group, Group C - Propofol with succinyl choline Group. Demographic Profile: In group A and C, 48% of patients are males and rest 52% are females, while in group B 52% of patients are males and rest females. The mean age of patient is 30.52, 30.12 and 30.84 in groups A, B and C respectively. The mean weight is 51.8, 53 and 53.22 in groups A, B and C respectively. Patients in each group were statistically comparable in relation to sex, age and weight. SUMMARY: In this study, the conditions of LMA insertion, patient’s response to LMA insertion and the hemodynamic changes during and after LMA insertion in the following three groups of patients were observed. Group A - Inj. Propofol 2.5mg/kg only. Group B - Inj. Propofol 2.5 mg/kg + 0.04mg/kg midazolam. Group C- Inj. Propofol 2.5 mg/kg + 0.1 mg/kg succinyl choline. • The jaw relaxation was adequate in 100% of Group B patients compared to 32 % of patients in Group A and 64% in Group C. • Overall insertion conditions were excellent in 100% of patients in Group B compared to 32% in Group A and 44% in Group C. • LMA was inserted successfully in the first attempt in 100% of patients in Group A compared to 40% in Group A and 64% in Group C. • Airway trauma as evidenced by blood staining of LMA was found in 36% of patients in Group A and 32% in Group C while none of the patients in Group B had any airway trauma. • Post op myalgia was present in 40% of patients in Group C. • Patient movements were present in 48% of patients in Group A compared to 12% in Group C while no movement was present in any of the patient in Group B. • The total dose of Propofol required for successful insertion of LMA was 2.76mg/kg in Group A and 2.60 mg/kg in Group C, while it is the least 2.06mg/kg in Group B which is the cause of significant hemodynamic stability in patients of Group B CONCLUSION: To conclude, addition of Midazolam (0.04mg/kg) to the standard dose of propofol provides better LMA insertion conditions than the addition of mini-dose Succinyl Choline (0.1mg/kg).

Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care

ImportanceAntipsychotics are widely used for distressing symptoms of delirium, but efficacy has not been established in placebo-controlled trials in palliative care.ObjectiveTo determine efficacy of risperidone or haloperidol relative to placebo in relieving target symptoms of delirium associated with distress among patients receiving palliative care.Design, Setting, and ParticipantsA double-blind, parallel-arm, dose-titrated randomized clinical trial was conducted at 11 Australian inpatient hospice or hospital palliative care services between August 13, 2008, and April 2, 2014, among participants with life-limiting illness, delirium, and a delirium symptoms score (sum of Nursing Delirium Screening Scale behavioral, communication, and perceptual items) of 1 or more. InterventionsAge-adjusted titrated doses of oral risperidone, haloperidol, or placebo solution were administered every 12 hours for 72 hours, based on symptoms of delirium. Patients also received supportive care, individualized treatment of delirium precipitants, and subcutaneous midazolam hydrochloride as required for severe distress or safety.Main Outcome and MeasuresImprovement in mean group difference of delirium symptom score (severity range, 0-6) between baseline and day 3. Five a priori secondary outcomes: delirium severity, midazolam use, extrapyramidal effects, sedation, and survival.ResultsTwo hundred forty-seven participants (mean [SD] age, 74.9 [9.8] years; 85 women [34.4%]; 218 with cancer [88.3%]) were included in intention-to-treat analysis (82 receiving risperidone, 81 receiving haloperidol, and 84 receiving placebo). In the primary intention-to-treat analysis, participants in the risperidone arm had delirium symptom scores that were significantly higher than those among participants in the placebo arm (on average 0.48 Units higher; 95% CI, 0.09-0.86; P = .02) at study end. Similarly, for those in the haloperidol arm, delirium symptom scores were on average 0.24 Units higher (95% CI, 0.06-0.42; P = .009) than in the placebo arm. Compared with placebo, patients in both active arms had more extrapyramidal effects (risperidone, 0.73; 95% CI, 0.09-1.37; P = .03; and haloperidol, 0.79; 95% CI, 0.17-1.41; P = .01). Participants in the placebo group had better overall survival than those receiving haloperidol (hazard ratio, 1.73; 95% CI, 1.20-2.50; P = .003), but this was not significant for placebo vs risperidone (hazard ratio, 1.29; 95% CI, 0.91-1.84; P = .14).Conclusions and RelevanceIn patients receiving palliative care, individualized management of delirium precipitants and supportive strategies result in lower scores and shorter duration of target distressing delirium symptoms than when risperidone or haloperidol are added.Trial Registrationanzctr.org.au Identifier: ACTRN12607000562471.

Implementation of Intranasal Midazolam for Prolonged Seizures in a Child Neurology Practice.

Currently, evidence supports the use of intranasal midazolam as an effective, and in many cases, preferable treatment option for prolonged seizures in children. Despite this knowledge, intranasal midazolam is not routinely found as a standard of care. The goal of this project was to implement the use of intranasal midazolam as a rescue medication for prolonged seizures within a child neurology practice and, in doing so, create a model for implementation that would be replicable for other practice sites. This project focused on the development of a process to make intranasal midazolam available as a treatment option and then the creation of an educational intervention for providers within a child neurology practice. Provider surveys analyzed provider attitudes toward intranasal midazolam and its frequency of use. Because of this project, a dramatic increase in the prescribing of intranasal midazolam was observed within a child neurology practice.

Experience with palliative sedation (PS) in an inpatient oncology setting.

63 Background: Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely. Methods: This is a retrospective study of the use of PS in cancer patients who died at our comprehensive cancer center between March 1, 2012 and December 31, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms as stated in the progress notes. Patients who died in the ICU were excluded. The aim of our study was to evaluate PS practice patterns, describing its frequency, clinical indications and outcomes. Results: During the study period, 556 cancer patients died at the institution and 203 (36.5%) received PS. Main reasons for exclusion were death in the ICU (168 patients) and no use of midazolam or neuroleptics (77 patients). Patients who received PS as compared to those not sedated were younger (67.8 vs. 71.5 years-old, p = 0.007) and more likely to have a primary diagnosis of lung cancer (23% vs. 15% p < 0.001). Patients receiving PS were more likely to be seen by oncology/hematology rather than other specialties (70% vs 45% p < 0.001) and more likely to have a longer hospital stay from admission to death (47.9 days vs 26.2 days p < 0.001). Only 25 patients (12%) were seen by a dedicated palliative care team. The most common indications for sedation were dyspnea (51.5%) and delirium (19.5%) and the most common dugs used were midazolam (52.9%) or midazolam and a neuroleptic (39.2%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range – IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Median time from sedation to death was 27 hours (IQR 12-58). Conclusions: Palliative sedation is a common practice at our hospital and it is not associated with shortening of hospital stay. Further research is needed to identify factors that may affect the frequency and outcomes associated with palliative sedation.

Barriers to Seizure Management in Schools

The purpose of this study was to assess school nurses' perceptions of barriers to optimal management of seizures in schools. Eighty-three school nurses completed an electronic survey. Most agreed they felt confident they could identify a seizure (97.6%), give rectal diazepam (83.8%), and handle cluster seizures (67.1%), but fewer were confident they could give intranasal midazolam (63.3%), had specific information about a student's seizures (56.6%), or could swipe a vagus nerve stimulator magnet (47.4%). Nurses were more likely to be available at the time of a seizure in rural (17/20) (85%) versus suburban (21/34) (62%) or urban (8/25) (32%) schools (P = .001). School nurses are comfortable managing seizures in the school setting. However, a specific seizure plan for each child and education on intranasal midazolam and vagus nerve stimulator magnet use are needed. A barrier in urban schools is decreased availability of a nurse to identify seizures and administer treatment.

MON-P013: The Associations Between Use of Midazolam, Enteral Feeding and Gastrointestinal Complications in Patients with Neurologic Impairment

MON-P013: The Associations Between Use of Midazolam, Enteral Feeding and Gastrointestinal Complications in Patients with Neurologic Impairment

Are subcutaneous palliative medicines available and accessible: an out of hours (OOH) audit in sheffield

IntroductionNICE quality standards (2011) state palliative care drugs should be fully accessible 24/7. National drug shortages, insufficient local stockholdings and prescriptions for items not on the recommended palliative list can make this problematic especially out of hours (OOH). There is little research on referral patterns for accessing subcutaneous medicines OOH.ObjectivesDetermine if subcutaneous palliative medicines are fully available OOH Investigate whether supplies vary between hospital and community pharmaciesUnderstand referral patterns to access medicationMethodA 12 month retrospective audit of GP OOH supplies from a hospital pharmacy with a prospective 4 week audit and carer survey in a large community pharmacy providing OOH supplies.ResultsLocally derived standards from commissioned service set at 100% (n = 68 in GP OOH/hospital, n = 21 in community pharmacy).100% of core subcutaneous medicines were available 24/7. Use of midazolam, diamorphine and hyoscine butylbromide similar across both settings; however levomepromazine was more common in the community following a national shortage of haloperidol. See table 1.29% of community pharmacy issues were for formulations not on the recommended palliative list.80% (4/5) patient referrals were made to the community pharmacy; 20% (1/5) going to more than one pharmacy.Abstract 61 Table 1Subcutaneous palliative care drug suppliesDrug nameGP OOH/hospital pharmacy suppliesNo. (%)Community pharmacy suppliesNo. (%)Midazolam Injection (various strengths)19 (28)5 (24)Diamorphine Injection (various strengths)17 (25)8 (38)Haloperidol Injection 5 mg5 (7)1 (5)Hyoscine Butylbromide Injection 20 mg13 (19)4 (19)Levomepromazine Injection 25 mg1 (1)3 (14)Morphine Injection 10 mg3 (4)0 (0)Oxycodone Injection (various strengths)6 (9)0 (0)Other Injections4 (6)0 (0)Total6821ConclusionSubcutaneous palliative care drugs are fully available in the OOH setting however further research should be undertaken to assess referral patterns.ReferenceNational Institute for Health and Care Excellence (NICE). Quality Standard 13 End of life care for adults. London: NICE; 2011

Adverse Drug Reaction with Midazolam Use in Emergency Department

Midazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.

Perioperative factors associated with Hospital Consumer Assessment of Healthcare Providers and Systems responses of total hip arthroplasty patients

ObjectiveTo determine perioperative treatments and events associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) responses among patients who undergo total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). DesignRetrospective analysis. SettingSingle tertiary care, academic, urban, level 1 trauma center. ParticipantsFinal cohort represents 301 consecutive surgical inpatients meeting criteria for evaluation by HCAHPS survey. ExposuresResponses to 4 HCAHPS questions were analyzed against perioperative treatments and events. MeasuresPositive and negative responses to HCAHPS questions. ResultsTHA patients responding affirmatively to both pain specific and general satisfaction were associated with preoperative use of chronic nonsteroidal anti-inflammatory drugs. In addition, THA patients responding affirmatively “how often was your pain well controlled” were also associated decreased postanesthesia care unit (PACU) opioid requirement. TKA patients responding affirmatively to “what number would you use to rate this hospital” were associated with shorter PACU stays and lower final pain scores. TKA patients responding affirmatively to “would you recommend this hospital to your family” were associated with shorter lengths of stay in the hospital and in the PACU. TKA patients responding affirmatively to “How often did the hospital staff do everything to help with your pain” were not associated with any measured perioperative event. TKA patients responding affirmatively to “how often was your pain well controlled” were associated with older age, decreased use of preoperative chronic benzodiazepines, and increased use of preoperative midazolam. ConclusionsThese data suggest that chronic use of nonsteroidal anti-inflammatory drugs is associated with improved overall satisfaction and satisfaction with pain in THA patients. Furthermore, increased PACU opioid use was negatively associated satisfaction with pain management. Age, lengths of stay preadmission medications, anxiolytic medications, and PACU pain scores are associated with patient satisfaction with regards to both pain management and overall satisfaction in TKA patients.

Analgesic and Sedative Effects of Dezocine and Midazolam During Vitrectomy

ABSTRACTPurpose: To evaluate the analgesic and sedative effectiveness of dezocine and midazolam in vitrectomy.Methods: One hundred and sixty patients undergoing vitrectomy were randomized into four groups. The control group was given local anesthetic in retrobulbar nerve block only, while the other three groups received a single dose of 0.1 mg/kg dezocine or/and 0.05 mg/kg midazolam (groups D, M, DM), respectively, at 10 min before retrobulbar block. Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2) were recorded prior to local anesthesia (Tp), at the start of surgery (T0), 5, 15, 30 min during (T1–T3), and at the end of surgery (T4). Pain at T2 and T4 was assessed by Numeric Rating Scale (NRS). Level of sedation at T2 was assessed using the Ramsay scale. Postoperative nausea and vomiting (PONV) events were recorded for 24 h.Results: Group DM showed a decrease in HR during T0–T4 compared to Tp (p < 0.001). The MAP of all groups decreased significantly at T0 compared to Tp (p < 0.05), but remained unchanged at T1–T4. At T2, all groups have lower pain level than control (p < 0.001), while group DM showed the lowest pain level. At T4, groups D and DM showed a lower pain level than control (p < 0.01). Groups M and DM showed a higher Ramsay score than group C (p < 0.01). Compared with control, group D had a higher PONV rate (p < 0.1). Groups M and DM showed a lower PONV rate than group D (p < 0.0001), and group M had a lower PONV rate than group C (p < 0.01).Conclusion: Combinatory use of dezocine and midazolam in addition to local anesthetic in retrobulbar nerve block can help relief pain and anxiety during vitrectomy and reduce PONV.

Comparative study between caudal bupivacaine and caudal midazolam for post-operative analgesia in paediatric patients

Introduction: Caudal epidural block is the most commonly used regional technique for post-operative analgesia in children. Because of the side effects of bupivacaine which include motor weakness, urinary retention and cardiovascular and central nervous system toxicity, this study was conducted to evaluate the use of epidural midazolam as an alternative analgesic to bupivacaine for children undergoing inguinal hernoitomy Methods: After prior permission from the Institutional Ethical Committee, 60 boys, aged 1-10 years, posted for unilateral inguinal herniotomy were selected. The patients were allocated randomly into two groups (n=25) to receive caudal injection of either 0.25% Bupivacaine 1 ml/kg (group B) or Midazolam 50 microg/kg with normal saline 1 ml/kg (group M). In the post operative period heart rate, blood pressure, pain score, recovery to first analgesic time, total number of analgesics required in 24 hours and side effects if any were noted and analysed. Results: There were no significant differences in quality of pain relief, postoperative behaviour or analgesic requirements between the Midazolam group and the Bupivacaine group. Recovery to first analgesic time though was longer in the Bupivacaine group (9.65 hr) than Midazolam group (7.32 hr); it was statistically not significant (P= 0.9). Any of the side effects such as motor weakness, urinary retention, and respiratory depression were not observed in both the groups. However in both the groups, few of the patients had post-operative vomiting. Conclusion: We conclude that caudal Midazolam in a dose of 50 microg/kg provides equivalent analgesia to Bupivacaine 0.25%, when administered in a volume of 1 ml/kg for children undergoing unilateral inguinal herniotomy for hernia or high ligation of processus vaginalis for hydrocoele.

Sedation and Local Anesthesia as an Alternative to General Anesthesia in 3 Birds

Sedation combined with local anesthesia can provide a safe alternative to general anesthesia or simple manual restraint for a variety of minor surgical procedures in captive birds. The following case reports demonstrate the use and safety of midazolam and butorphanol, along with local lidocaine and bupivacaine for various procedures including mass removal and digit amputation. In each case, sedation allowed restraint with minimal patient stress with the local block appearing to provide adequate analgesia. Each patient experienced an uneventful recovery.

A randomized trial examining preoperative sedative medication and postoperative sleep in children

Study ObjectiveMidazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of preoperative use of midazolam with postoperative sleep. The purpose of this investigation was to compare postoperative sleep in children as a function of preoperative sedative medication use. DesignThis study was a 2-group randomized controlled trial. SettingParticipants were recruited from Yale-New Haven Children's Hospital. PatientsParticipants included a convenience sample of 70 children between the ages of 3 to 12 years undergoing ambulatory tonsillectomy and adenoidectomy. InterventionsChildren were randomly assigned to 1 of 2 groups: a control group who received preoperative acetaminophen only (n = 32) and an experimental group who received both acetaminophen and midazolam preoperatively (n = 38). MeasurementsParents completed measures of postoperative behavioral recovery and a subset of children wore actigraphs to examine objective sleep data. Main ResultsChildren who received midazolam experienced similar sleep changes compared to children in the control group. The actigraph data revealed that children who received midazolam were awake significantly less during the night compared to the control group (P= .01). ConclusionChildren who received midazolam before surgery had similar postoperative sleep changes compared to children who did not receive midazolam. Further understanding of the postoperative behavioral effects of midazolam on children will help guide healthcare providers in their practice.

Midazolam dose correlates with abnormal hippocampal growth and neurodevelopmental outcome in preterm infants.

Very preterm-born neonates (24-32 weeks of gestation) are exposed to stressful and painful procedures during neonatal intensive care. Analgesic and sedation therapies are essential, and opiates and benzodiazepines are commonly used. These medications may negatively impact brain development. The hippocampus may be especially vulnerable to the effects of pain and analgesic and/or sedative therapies and contribute to adverse outcomes. The effect of invasive procedures and analgesic-sedative exposure on hippocampal growth was assessed, as was that of hippocampal growth on neurodevelopmental outcome. A total of 138 neonates (51% male, median gestational age = 27.7 weeks) underwent magnetic resonance imaging and diffusion tensor imaging (DTI) scans, early in life (postmenstrual age [PMA] = 32.3 weeks) and at term-equivalent age (PMA = 40.2 weeks). Volumes and DTI measures of axial diffusivity, radial diffusivity, and mean diffusivity (MD) were obtained from the hippocampus. Cognitive, language, and motor abilities were assessed using the Bayley Scales of Infant Development-III at 18.7 months median corrected age. Models testing the association of invasive procedures with hippocampal volumes and DTI measures accounted for birth gestational age, sex, PMA, dose of analgesics/sedatives (fentanyl, morphine, midazolam), mechanical ventilation, hypotension, and surgeries. Total midazolam dose predicted decreased hippocampal volumes (β = -1.8, p < 0.001) and increased MD (β = 0.002, p = 0.02), whereas invasive procedures did not (β = 0, p > 0.5 each). Lower cognitive scores were associated with hippocampal growth (β = -0.31, p = 0.003), midazolam dose (β = -0.27, p = 0.03), and surgery (β = -8.32, p = 0.04). Midazolam exposure was associated with macro- and microstructural alterations in hippocampal development and poorer outcomes consistent with hippocampal dysmaturation. Use of midazolam in preterm neonates, particularly those not undergoing surgery, is cautioned.

Monotherapy or Polytherapy for First-Line Treatment of SE?

Status epilepticus (SE) is one of the most frequent neurologic emergencies, and a rapid and effective treatment is warranted. Current guidelines recommend a stepwise approach using a sequence of different antiepileptic drugs with benzodiazepines (BZD) being the first treatment proposed. To provide the more effective treatment as soon as possible, some authors have suggested using a combined polytherapy as first-line treatment. Strong evidence supports the use of benzodiazepines, mostly lorazepam and midazolam as initial monotherapy treatment for SE. Insufficient data are available to support the use of nonsedating antiepileptic drugs as phenytoin, valproic acid, or levetiracetam without a previous benzodiazepine administration. Studies assessing the role of a combined initial therapy are rare, if not missing. Moreover, owing the wide range of SE etiologies, a "one fits all" initial polytherapy seems difficult to achieve. After reviewing the available evidence, guidelines, and current practices regarding monotherapy and polytherapy as first-line treatment in SE in adults, the authors propose a rational algorithm for early antiseizure treatment in SE.

Premedication with midazolam in intellectually disabled dental patients: intramuscular or oral administration? A retrospective study.

BackgroundThe use of midazolam for dental care in patients with intellectual disability is poorly documented. The purpose of this study was to determine which method of premedication is more effective for these patients, 0.15 mg/kg of intramuscular midazolam or 0.3 mg/kg of oral midazolam.Material and MethodsThis study was designed and implemented as a non-randomized retrospective study. The study population was composed of patients with intellectual disability who required dental treatment under ambulatory general anesthesia from August 2009 through April 2013. Patients were administered 0.15 mg/kg of midazolam intramuscularly (Group IM) or 0.3 mg/kg orally (Group PO). The predictor variable was the method of midazolam administration. The outcome variables measured were Observer’s Assessment of Alertness/ Sedation (OAA/S) Scale scores, the level of cooperation when entering the operation room and for venous cannulation, post-anesthetic agitation and recovery time.ResultsMidazolam was administered intramuscularly in 23 patients and orally in 21 patients. More patients were successfully sedated with no resistance behavior during venous cannulation in Group PO than in Group IM (p=0.034). There were no differences in demographic data and other variables between the groups.ConclusionsThe results of this study suggest that oral premedication with 0.3 mg/kg of midazolam is more effective than 0.15 mg/kg of midazolam administered intramuscularly, in terms of patient resistance to venous cannulation. If both oral and intramuscular routes of midazolam are acceptable in intellectually disabled patients, the oral route is recommended. Key words:Premedication, midazolam, intellectual disability.

Intranasal dexmedetomidine versus midazolam in preoperative sedation for noncomplex pediatric congenital cardiac surgeries

Background & objectives Preoperative anxiety can be reduced pharmacologically. Midazolam is a benzodiazepine potent sedative, hypnotic, anaesthetic agent with strong anticonvulsant properties but does not have analgesic properties. The administration of intranasal lidocaine prior to the use of intranasal midazolam has been reported to be beneficial in reducing the burning sensation from intranasal midazolam. Dexmedetomidine, the newest sedative, is a highly selective α2 adrenergic agonist. Materials and methods Sixty children, aged between 3–12 years. The children were divided into two groups of 30 each. Thirty minutes before induction, Group-D (n=30) received intranasal Dexmedetomidine and Group M+L received intranasal midazolam preceeded by single puff on intranasal lidocaine spray 1% in each nostril. Results Children who were premedicated with intranasal dexmedetomidine had lower sedation (MOAA/S Scale) scores, and easier child-parent separation than children who received intranasal midazolam. In addition to lower BIS measurements at the OR, after face mask application and after IV cannulation. Conclusion Intranasal Dexmedetomidine can be used effectively and safely as a preanaesthetic medication in children undergoing repair of non-complex congenital cardiac defects.

Effects of combined midazolam and propofol in anesthesia induction and recovery of cats undergoing ovariohisterectomy

&lt;p&gt;The objective of this study was to determine the effects of propofol and midazolam on induction of anesthesia in cats undergoing ovariohysterectomy, measured in terms of the quality of tracheal intubation, anesthesia induction, cardiorespiratory effects, and recuperation period. Thirty healthy adult cats were pretreated with acepromazine and morphine. After 30 min, they were divided into three groups: PG (n = 10), in which induction was performed with only intravenous propofol at doses required for intubation; MPG (n = 8), in which animals received intravenous midazolam (0.3 mg kg-1) administered over 30 s, followed by administration of propofol as in PG; and PMG (n = 9), in which propofol was first administered at a rate of 4 mg kg-1 min-1, after which midazolam was administered (0.3 mg/kg), followed by re-administration of propofol. In order to perform a blinded study, the PG and PMG received a 0.9% NaCl solution volume similar to the midazolam dose before induction (0.06 mL/kg). Similar to the other groups, the PG and MPG received (0.06 mL kg-1) saline 30 s after administration of propofol. In order to mimic the administration of midazolam, the saline solution was administered for 30s. The PG received 11.0 ± 1.38 mg kg-1 propofol, a greater dose than that administered to the PMG (p &amp;lt; 0.001) and MPG (p &amp;lt; 0.01), which received 7.9 ± 1.92 and 9.1 ± 2.20 mg kg-1, respectively. There were no differences in the intubation scores between groups. Previous use of midazolam did not affect agitation or excitement in cats; both sequences of propofol-midazolam administration are feasible, but the propofol-midazolam sequence was superior due to the lower propofol dose.&lt;/p&gt;