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Sample records for farmacovigilancia del midazolam

  1. Principales resultados del sistema cubano de farmacovigilancia en el año 200

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    Francisco Debesa García

    2003-08-01

    Full Text Available Se describe el funcionamiento y principales resultados del sistema cubano de farmacovigilancia durante el año 2001 en todos los niveles de salud del país. Durante 12 meses, los casos se identificaron mediante el sistema de notificación voluntaria de sospecha de reacciones adversas a medicamentos. Se recibieron en la Unidad Nacional Coordinadora de Farmacovigilancia 16 195 notificaciones de Reacciones Adversas Medicamentosas (RAM que contenían 33 601 sospechas de RAM, para una tasa de notificación de 1 447 reportes x 1 000 000 de habitantes, el 60,2 % de las RAM correspondió al sexo femenino y el 39,8 % al masculino. En cuanto al nivel de asistencia, la atención primaria es la que más notifica con 83,3 %, fueron resultados alentadores que en el año 2001 la relación de reacciones moderadas y graves respecto a leves (59,2 %/40,6 % continua favorable al incremento de notificaciones de mayor severidad. Se reportaron 33 reacciones con desenlace fatal, para un 0,2 %. Las notificaciones recibidas en nuestra unidad nos permitieron cuantificar y caracterizar las RAM, teniendo además un gran valor para generar alertas y vigilar la seguridad de los medicamentos que circulan en nuestro país.The functioning and main results of the Cuban Drug Surveillance System in the year 2001 at all the health care levels throughout the country are described. In that period, cases were identified by the Voluntary Notification of suspected adverse drug reaction System. The National Coordinating Unit of Drug Surveillance received 16 195 notes on Adverse Drug Reactions that included 33 601 suspected adverse drug reactions, for a notification rate of 1 447 reports per 1 000 000 pop.; 62% of adverse drug reactions were reported in females and 39,8% in males. Regarding the level of assistance, primary health care level is the one that presented more reports with 83,3% of the total amount. Results were encouraging in the year 2001 since the ratio of moderate and

  2. FARMACOVIGILANCIA: ESTUDIO DE REACCIONES ADVERSAS A MEDICAMENTOS EN ANIMALES DE COMPAÑIA EN LAS COMUNAS DEL GRAN SANTIAGO

    OpenAIRE

    IRAGUEN CONTRERAS, DANIELA MACARENA

    2010-01-01

    La administración de un fármaco, ya sea con fines terapéuticos, profilácticos o de diagnóstico puede producir reacciones adversas a medicamentos (RAMs) en los pacientes. La farmacovigilancia considera la recopilación de información de estas reacciones, siendo su principal objetivo mejorar la seguridad y la eficacia clínica de los fármacos una vez que estos son comercializados. En Chile, no se cuenta con estudios sistemáticos dirigidos a identificar y cuantificar las RAMs en la medicina veteri...

  3. FARMACOVIGILANCIA: ESTUDIO DE REACCIONES ADVERSAS A MEDICAMENTOS EN ANIMALES DE COMPAÑÍA EN LAS COMUNAS DEL GRAN SANTIAGO

    OpenAIRE

    IRAGUEN CONTRERAS; DANIELA MACARENA

    2010-01-01

    La administración de un fármaco, ya sea con fmes terapéuticos, profilácticos o de diagnóstico puede producir reacciones adversas a medicamentos (RAMs) en los pacientes. La farmacovigilancia considera la recopilación de información de estas reacciones, siendo su principal objetivo mejorar la seguridad y la eficacia clínica de los fármacos una vez que estos son comercializados. En Chile, no se cuenta con estudios sistemáticos dirigidos a identificar y cuantificar las RAMs en la m...

  4. Principales resultados del sistema cubano de Farmacovigilancia en el año 2004 Main results of the Cuban system of pharmacological surveillance system in 2004

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    Francisco Debesa García

    2005-12-01

    Full Text Available Se describen los principales resultados alcanzados por el sistema cubano de Farmacovigilancia en el 2004. Durante 12 meses, los casos se identificaron mediante el sistema de notificación voluntaria de sospecha de reacciones adversas a medicamentos. Se recibieron en la Unidad Nacional Coordinadora de Farmacovigilancia 7 063 notificaciones de reacciones adversas medicamentosas (RAM que contenían 13 500 a razón de 1,9 RAM por notificación, de ellas 3 185 fueron “importantes” para el 35,1 % (según criterios para determinar RAM importantes de la UCNFv , en las Normas y procedimientos de trabajo del sistema cubano de Farmacovigilancia. La tasa de notificación anual fue de 628 notificaciones por millón de habitantes. El 64,6 % de las RAM correspondió al sexo femenino y el 35,4 % al masculino. En cuanto al nivel de asistencia, la atención primaria fue la que más notificó con 85 %. La relación de reacciones leves con respecto a las moderadas y graves fue de 48,3/51,4 %, que continúa con un balance muy bueno en relación con el reporte por severidad. Se reportaron 23 reacciones con desenlace fatal, para el 0,3 %. A pesar de la disminución en cuanto al número de notificaciones recibidas en nuestro unidad, con respecto al año anterior, aún se encuentra entre las tasas de notificación más altas de los países miembros del sistema internacional de monitoreo de RAM; por otra parte, dada la calidad de estas permitieron cuantificar y caracterizar las RAM, teniendo además un gran valor para generar alertas y vigilar la seguridad de los medicamentos que circulan en nuestro país.The main results achieved by the Cuban Pharmacological Surveillance System in the year 2004 were described. During these 12 months, the cases were identified by the voluntary notification system of suspected adverse reactions to drugs. The National Coordinating Unit of Pharmacological Surveillance (NCUPs received 7 063 notifications that included 13 500 adverse drug

  5. Midazolam

    Science.gov (United States)

    Midazolam comes as a syrup to take by mouth. It is usually given as a single dose by a doctor or nurse before a medical ... phenytoin (Dilantin); methylphenidate (Concerta, Metadate, Ritalin, others); nefazodone; ranitidine (Zantac); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane). Your ...

  6. Efecto sedante del midazolam genérico versus innovador en ratas Wistar

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    Radamés Alemón-Medina

    2015-11-01

    Full Text Available Antecedentes: ocho de cada diez pacientes en Terapia Intensiva del Instituto Nacional de Pediatría no obtienen el mismo efecto ansiolítico y sedante con midazolam genérico (PiSA®, que con el innovador (Dormicum, Roche® a pesar de que su biodisponibilidad es de 100%.  Objetivo: determinar diferencias significativas en el efecto sedante del midazolam genérico y del innovador administrados parenteralmente.  Material y métodos: estudio aleatorizado cruzado en 24 ratas Wistar macho distribuidas en 4 grupos (n=6. A cada individuo se le administró una dosis de 0.5 mg/kg de peso vía intraperitoneal. Se determinaron los grados de sedación mediante la escala de Salamone. Se midió la concentración del fármaco en las ampolletas de ambas marcas por cromatografía líquida de alta resolución. Resultados: el efecto sedante del midazolam apareció al mismo tiempo y tuvo la misma duración, ndependientemente de la marca. El efecto tiende a ser más duradero con el innovador pero sin ser estadísticamente significativo (ANOVA, p ≤ 0.05. Asimismo, la mayoría de los animales llegaron al nivel 3 de sedación con ambas marcas.   Conclusión: tanto el midazolam innovador como el genérico tienen el mismo efecto sedante: aparece al mismo tiempo y tiene la misma duración.

  7. Estrategia de trabajo a seguir en Laboratorios Liorad para la farmacovigilancia desde la industria

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    Nancy Burguet Lago

    Full Text Available Introducción: la farmacovigilancia es una responsabilidad que comparten los médicos, la industria farmacéutica, las autoridades sanitarias y los pacientes. En Laboratorios Liorad no estaba definida la implementación de esta actividad. Objetivo: establecer la estrategia de trabajo a seguir por la referida institución para asumir la farmacovigilancia desde la industria. Métodos: se trazaron las estrategias siguientes: seleccionar una persona para asumir la actividad, definir el marco regulatorio que regiría esta, establecer cómo se llevaría a cabo el flujo de la información, definir el sistema documental para obtener evidencia documentada y valorar el diseño para realizar los estudios de poscomercialización. Resultados: se definió un especialista del área de Investigación, Desarrollo e Innovación para la actividad de farmacovigilancia; así como sus funciones de trabajo. El profesional designado recibió capacitación en farmacovigilancia orientada a la industria. Se definió como marco regulatorio las normas que rigen esta acción en Cuba. Se confeccionaron, revisaron y aprobaron los documentos para facilitar la organización y dejar constancia del trabajo realizado. Por último, como diseño fundamental para realizar los estudios de poscomercialización se definió realizar la investigación de eventos adversos raros e inesperados y la detección de aumentos en la incidencia de reacciones adversas conocidas. Conclusiones: al término del trabajo existe una infraestructura organizativa en la empresa que permite asumir esta tarea desde la industria, lo que contribuirá a detectar precozmente manifestaciones inesperadas que pudieran alterar el balance riesgo-beneficio de los medicamentos fabricados en Liorad durante su empleo.

  8. Farmacovigilancia: Una herramienta poco utilizada Pharmacoepidemiology: An unappreciated tool

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    Walter Vasen

    2006-06-01

    Full Text Available La farmacovigilacia es una herramienta esencial para el control de los fármacos utilizados en nuestro país, el presente artículo muestra una revisión de los elementos más destacados en el tema y un resumen de los sistemas regulatorios vigentes en la Argentina y de la experiencia de la Red de Farmacovigilancia de los hospitales del Gobierno de la Ciudad de Buenos Aires, con el objetivo de informar y estimular a los colegas a la denuncia de los efectos adversos de los medicamentos.Pharmacoepidemiology is an essential tool for controlling drugs used in our country. The present article reveals the most relevant aspects on the topic, summarizes regulatory tools currently used in Argentina and explores the experience of the Pharmacoepidemiology Network in public hospitals of Buenos Aires City. The aim is to inform and stimulate colleagues to report adverse effects of drugs.

  9. Adecuación de ranelato de estroncio tras alertas de farmacovigilancia en un área de gestión sanitaria

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    M.R. Cantudo-Cuenca

    2016-01-01

    Conclusiones: El número de pacientes con prescripción de ranelato de estroncio ha disminuido considerablemente. Las intervenciones dirigidas a la revisión de la adecuación del tratamiento, en base a las alertas de farmacovigilancia han sido efectivas.

  10. Reacciones adversas graves y mortales a los antimicrobianos. Sistema Cubano de Farmacovigilancia, 2003-2012

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    Ismary Alfonso Orta

    Full Text Available Introducción: las reacciones adversas a los antimicrobianos ocasionan más de 142 000 visitas a las salas de urgencias hospitalarias por año en los Estados Unidos. En Cuba han ocupado el primer lugar en el reporte, por ejemplo, en el año 2008 representaron el 31,4 % del total de las reacciones adversas graves y el 25 % de las reacciones adversas mortales. Objetivo: caracterizar las reacciones adversas graves y mortales a los antimicrobianos notificadas a la Unidad Nacional Coordinadora de Farmacovigilancia, durante el periodo 2003-2012. Métodos: se realizó un estudio de farmacovigilancia, observacional, descriptivo y transversal, utilizando la base de datos nacional de farmacovigilancia durante el periodo 2003-2012. Se trabajó con el total de reportes de reacciones adversas graves y mortales a los antimicrobianos. Las reacciones adversas se clasificaron según tipo de reacción, sistema de órgano afectado, imputabilidad y frecuencia. Se identificaron los principales antimicrobianos sospechosos y se estudiaron los pacientes que presentaron reacciones adversas según sexo y edad. Resultados: se detectaron 631 sospechas de reacciones adversas graves y mortales a los antimicrobianos, de ellas fueron 550 graves y 81 mortales. Predominaron el sexo femenino con 60,1 % y 405 adultos. Las reacciones adversas comprometieron los sistemas: general (30,4 %, respiratorio (25,2 % y cardiovascular (14,9 %. El shock anafiláctico fue la reacción más reportada y la penicilina el fármaco más relacionado con esta. El 73,5 % fueron probables y el 58,9 % ocasionales. Conclusiones: las reacciones adversas graves y mortales predominaron en el sexo femenino y en los adultos. La penicilina fue el fármaco más relacionado. Las reacciones adversas probables y ocasionales fueron la mayoría en el estudio.

  11. Azitromicina y efectos cardiovasculares notificados al Sistema Cubano de Farmacovigilancia, 2003-2012

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    Ismary Alfonso Orta

    Full Text Available Introducción: la azitromicina, es un antibacteriano macrólido semisintético, al cual se han asociado efectos cardiovasculares, como la prolongación del intervalo QT y trastornos del ritmo que pueden ser fatales. La FDA alertó sobre un pequeño aumento de la mortalidad y riesgo de muerte en personas tratadas durante 5 días con este antibacteriano, y en el Centro Internacional de Monitoreo de Uppsala también se han registrado casos. Objetivo: caracterizar las reacciones adversas cardiovasculares a la azitromicina informadas a la Unidad Nacional Coordinadora de Farmacovigilancia durante el periodo 2003-2012. Métodos: estudio observacional, descriptivo y transversal utilizando la base de datos nacional de farmacovigilancia y las notificaciones espontáneas de reacciones adversas. Se trabajó con el universo de pacientes con reacciones adversas a la azitromicina. Las reacciones cardiovasculares se clasificaron según tipo de reacción, severidad, imputabilidad y frecuencia. Se estudiaron los pacientes que presentaron reacciones adversas según sexo y edad. Resultados: se recibieron 1 960 notificaciones de reacciones adversas a la azitromicina en el periodo de estudio, de las cuales 96 se correspondieron con reacciones adversas cardiovasculares para el 4,9 %. Predominaron en el sexo femenino (55,2 % y en los adultos (75 %. Las palpitaciones representaron el 44,8 % (43 pacientes, seguidas de la taquicardia y el dolor torácico. El 67,7 % resultaron moderadas, el 71,9 % probables y el 60,4 % ocasionales. El 31,3 % de las reacciones se pudo haber evitado y el motivo que predominó fue la indicación inadecuada en el 70 %. Conclusiones: aunque no se informan reacciones adversas cardiovasculares con desenlace fatal en personas tratadas con azitromicina, la tercera parte de ellas se podrían haber evitado; por lo se recomienda realizar una vigilancia más proactiva a este medicamento, así como informar todas las reacciones al Sistema Cubano de

  12. Presente y futuro de la farmacovigilancia en la Industria Farmacéutica

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    Iván E. Cuevas

    2007-04-01

    Full Text Available Se realizó un estudio sobre los problemas de la vigilancia poscomercialización desde la industria farmacéutica. Las reacciones adversas a medicamentos y vacunas causan un aumento significativo en los costos de la atención sanitaria; las vacunas en particular tienen un beneficio diferido y desconocido y un riesgo inmediato, por lo cual se requiere de mayores estándares de vigilancia. La farmacovigilancia por sí misma tiene obstáculos que pueden ser mayores cuando se enfocan desde la industria farmacéutica. El acompañamiento o apadrinamiento como estrategia permite vencer esos obstáculos y establecer el sistema de vigilancia poscomercialización, lo cual ha sido práctica sistemática del Instituto Finlay y es la concreción de cómo se debe asumir un mayor nivel de responsabilidad en los productos con el ciclo completo. La experiencia en nuestro Instituto con relación al enfoque poscomercialización, donde se observan todos los factores y condiciones que inciden en efectos deseados o no de los productos, es un adelanto para que con la aplicación de herramientas epidemiológicas y farmacoeconómicas, obtener una mejor evaluación del impacto sanitario y económico en la aplicación de nuestras vacunas. La implementación y puesta en marcha de la farmacovigilancia en la industria de medicamentos es un desafío y una necesidad para completar el desarrollo de la industria farmacéutica.

  13. Comparación de la efectividad del midazolam en niños: via oral y via intranasal

    OpenAIRE

    Castro Jerí, Esmeralda Soledad; Facultad de Estomatología, Universidad Peruana Cayetano Heredia. Lima,; Díaz-Pizán, Maria Elena; Facultad de Estomatología, Universidad Peruana Cayetano Heredia. Lima,; Vargas Machuca, Mónica Valdivieso; Facultad de Estomatología, Universidad Peruana Cayetano Heredia. Lima,

    2014-01-01

    El propósito del presente estudio fue evaluar la efectividad de dos formas de administración demidazolam, vía oral e intranasal en la modificación de la conducta de niños en edad preescolarquienes recibieron tratamiento dental. Participaron 20 niños con edades entre los 22 a 68meses, quienes recibieron midazolam en dosis de 0,5mg/kg de peso administrado por vía oral y0,2 mg/kg de peso administrado por vía intranasal. A todos los niños se les registró la presiónarterial, frecuencia cardiaca y ...

  14. Midazolam Injection

    Science.gov (United States)

    ... injection is in a class of medications called benzodiazepines. It works by slowing activity in the brain ... breast-feeding.talk to your doctor about the risks and benefits of receiving midazolam injection if you ...

  15. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual

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    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.

  16. Estudio exploratorio de farmacovigilancia en el personal médico

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    María de los Ángeles Peña Machado

    2000-01-01

    Full Text Available La farmacovigilancia es un procedimiento que depende en gran medida del médico, con el objetivo de determinar las posibles causas de la escasa notificación de reacciones adversas de los medicamentos (RAM en nuestro medio. Se aplicó una encuesta anónima a 145 profesionales de la medicina, de 17 especialidades diferentes de los cuales 68 eran de la Atención Primaria (AP y 77 de la Secundaria (AS. En la AP el 40 % eran especialistas y el 68 % residentes, en la AS el 100 % eran especialistas. Se observaron diferencias significativas entre la AP y la AS en la mayoría de las respuestas de las preguntas formuladas. Los resultados nos permiten concluir que los médicos tienen conocimientos y experiencia relacionados con las RAM, pero la divulgación y el mecanismo de notificación deben mejorar de manera que los estimule a reportarlas.Drug surveillance is a procedure that depends greatly on the doctor with the objective of determining the possible causes of the poor notification of the adverse reactions of drugs (ARD in our environment. An anonymous survey was done among 145 medical professionals from 17 different specialities. 68 worked at the primary care level (PCL and 77 at the secondary care level (SCL. At the primary care level 40 % were specialists and 68 % residents, whereas at the secondary level 100 % were specialists. Significant differences were observed between the PCL and the SCL in most of the answeres given to the questions. The results allowed to conclude that doctors have experience and know about the adverse reactions of drugs but that the divulgation and the mechanism of modification should be improved in order to encourage doctors to report them.

  17. Midazolam por via oral como medicação pré-anestésica em crianças e adolescentes com paralisia cerebral: estudo comparativo das variações do índice bispectral Midazolam por vía oral como medicación preanestésica en niños y adolescentes con parálisis cerebral: estudio comparativo de las variaciones del índice bispectral Oral midazolam as pre-anesthetic medication in children and teenagers with cerebral palsy: a comparative study on the variations of the bispectral index

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    Verônica Vieira da Costa

    2009-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O midazolam é um derivado benzodiazepínico com ação hipnótica e muito utilizado como medicação pré-anestésica em anestesia pediátrica. As crianças com paralisia cerebral (PC também se beneficiam do uso do midazolam, mas seus efeitos são ainda desconhecidos sobre esse grupo de pacientes que apresentam uma série de particularidades, com alterações inclusive no local de ação do midazolam. O objetivo do estudo foi avaliar a ação do midazolam utilizado como medicação pré-anestésica sobre o índice bispectral (EEG-BIS dos pacientes com paralisia cerebral. MÉTODO: Foram avaliados dois grupos de pacientes: um com diagnóstico de PC e outro sem doença do sistema nervoso central (SNC e periférico. Foram registrados valores de EEG-BIS na enfermaria na véspera da operação e no dia da operação, 40 minutos depois da administração de 0,6 mg.kg-1 de midazolam via oral. Foram excluídos pacientes com história de reação paradoxal ao midazolam e pacientes do grupo-controle que estivessem em uso de outra medicação. RESULTADOS: Foram estudados 77 pacientes de ambos os sexos, entre 4 e 18 anos de idade. Não houve diferença entre os valores de EEG-BIS basal entre os grupos estudados. Após o uso do midazolam houve diminuição dos valores do EEG-BIS nos dois grupos estudados, com diferença estatística significativa em cada grupo. Na comparação entre grupos não houve diferença estatística. CONCLUSÕES: O midazolam administrado como medicação pré-anestésica na dose de 0,6 mg.kg-1 diminui os valores basais do EEG-BIS sem caracterizar hipnose e sem diferença estatística nos grupos estudados.JUSTIFICATIVA Y OBJETIVOS: El midazolam es un derivado benzodiazepínico con acción hipnótica y muy utilizado como medicación preanestésica en anestesia pediátrica. Los niños con parálisis cerebral (PC también se benefician del uso del midazolam, pero sus efectos todavía se desconocen sobre ese

  18. Ação do anticonvulsivante isolado e associado ao midazolam como medicação pré-anestésica sobre o índice bispectral (BIS em pacientes com paralisa cerebral Acción del antiepiléptico aislado y asociado al midazolam como medicación preanestésica sobre el índice bispectral (BIS en pacientes con parálisis cerebral Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the bispectral index (BIS in patients with cerebral palsy

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    Verônica Vieira da Costa

    2010-06-01

    ás utilizado como medicación preanestésica y no se conocen sus interacciones medicamentosas en los pacientes con PC. El objetivo de este estudio fue evaluar el midazolam como medicación preanestésica en el BIS de los pacientes con PC en uso crónico de antiepilépticos. MÉTODO: Se evaluaron tres grupos de pacientes: PC sin uso de antiepilépticos, PC en uso de antiepiléptico y otro grupo sin enfermedad y sin uso de medicaciones (grupo control. En la víspera de la cirugía, con los pacientes despiertos y en decúbito dorsal, fue colocado el monitor del BIS y se registraron los valores basales del BIS. Al día siguiente, 40 minutos antes de la cirugía, los pacientes recibieron 0,6 mg.kg-1 de midazolam por vía oral. Antes del inicio de la anestesia fue realizado el mismo procedimiento para registro del BIS, después del uso del midazolam. RESULTADOS: Fueron estudiados 107 pacientes, 39 pacientes del grupo control y 68 con diagnóstico de PC. De ellos, 17 usaban antiepilépticos. Con relación al valor promedio de BIS después del uso del midazolam, no hubo diferencia entres los pacientes del grupo control y del grupo PC que no tomaban antiepiléptico, mientras que los pacientes que usaban antiepilépticos fueron diferentes (p = 0,003. La posibilidad de disminución del BIS después del uso del midazolam, aumenta de acuerdo con el número de antiepiléptico usado por el paciente. CONCLUSIONES: El uso crónico de antiepiléptico asociado al midazolam vía oral como medicación preanestésica, puede conllevar a la disminución de los valores de BIS configurando niveles profundos de hipnosis.BACKGROUND AND OBJECTIVES: Patients with cerebral palsy (CP frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre

  19. Farmacovigilancia en medicina veterinaria: una perspectiva desde el punto de vista internacional y situación actual en Chile Pharmacovigilance in veterinary medicine: an international perspective and the current situation in Chile

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    D Iragiien

    2007-01-01

    Full Text Available La farmacovigilancia es una actividad dirigida a la detección y estudio de las reacciones adversas a medicamentos. Una reacción adversa corresponde a una reacción nociva no intencionada y que tiene lugar a las dosis normalmente utilizadas para la profilaxis, diagnóstico o tratamiento de una enfermedad o la modificación de funciones biológicas. A nivel internacional, países como los Estados Unidos de América, la Unión Europea, el Reino Unido y Australia han instaurado sistemas de farmacovigilancia, tanto para la medicina humana como veterinaria. Estos sistemas recopilan la información de reacciones adversas mediante notificaciones espontáneas. Las agencias reguladoras de cada país analizan estos datos y adoptan las medidas necesarias, ya sea para la modificación de los registros de medicamentos o para el retiro de éstos del mercado, como ha ocurrido específicamente para la medicina humana. En Chile, desde el año 1995, existe un programa de farmacovigilancia humana a cargo del Instituto de Salud Pública. Por el contrario, en la medicina veterinaria la evaluación de la seguridad y eficacia de medicamentos sólo se considera en el registro oficial otorgado por el Ministerio de Agricultura (Servicio Agrícola y Ganadero. Como consecuencia, la frecuencia y severidad de las reacciones adversas es desconocida. La experiencia extranjera refleja la importancia de contar con un programa de farmacovigilancia y las acciones necesarias para que éstos cumplan su objetivo. En este artículo se presenta un análisis de las fortalezas y debilidades de los programas internacionales de farmacovigilancia y la situación actual en ChilePharmacovigilance is an activity that involves the detection and evaluation of adverse drug reactions. These are unintended and harmful reactions which occur at doses that are normally used in animals for the prophylaxis, diagnosis or treatment of diseases or the modification of physiological function

  20. Farmacovigilancia intensiva en pacientes adultos y pediátricos

    Directory of Open Access Journals (Sweden)

    Isis B Bermúdez Camps

    1999-08-01

    Full Text Available Se estudiaron 600 pacientes, 320 niños y 280 adultos seleccionados aleatoriamente a partir de los 2 368 casos ingresados en las unidades de cuidados intensivos e intermedios de los hospitales Infantil Norte "Juan de la Cruz Martínez Maceira" y Provincial Clinicoquirúrgico Docente "Saturnino Lora". Se detectaron 511 reacciones adversas a medicamentos en 261 pacientes, 187 adultos y 74 niños, con un índice de aparición de este fenómeno del 61 y 20 % respectivamente. Los resultados obtenidos fueron procesados y evaluados mediante pruebas estadísticas, la aplicación del algoritmo de Naranjo y el cálculo del beneficio-riesgo de los tratamientos aplicados.600 patients (320 children and 280 adults were studied, who had been ramdonly selected from 2 368 cases admitted to the intensive and intermidiate care units in "Juan de la Cruz-Martínez Maceira" Northern Pediatric Hospital and "Saturnino Lora" Provincial Teaching Clinicosurgical Hospital. 511 adverse reactions to drugs were detected in 201 patients 187 adults and 74 children- with an occurrence index of 61 % and 20 % respectively. The result were processed and asseased through statistical tests, Naranjo’s algoritthm and benefit- risk analysis of used treatments.

  1. Farmacovigilancia intensiva en pacientes adultos y pediátricos

    OpenAIRE

    Isis B Bermúdez Camps; Nailet Real Bestard; José R Acosta Torres; Aurelio Rodríguez Fernández

    1999-01-01

    Se estudiaron 600 pacientes, 320 niños y 280 adultos seleccionados aleatoriamente a partir de los 2 368 casos ingresados en las unidades de cuidados intensivos e intermedios de los hospitales Infantil Norte "Juan de la Cruz Martínez Maceira" y Provincial Clinicoquirúrgico Docente "Saturnino Lora". Se detectaron 511 reacciones adversas a medicamentos en 261 pacientes, 187 adultos y 74 niños, con un índice de aparición de este fenómeno del 61 y 20 % respectivamente. Los resultados obtenidos fue...

  2. Coma mixedematoso y midazolam: Reporte de caso.

    Directory of Open Access Journals (Sweden)

    Miguel Pinto Valdivia

    2008-10-01

    Full Text Available Se reporta el caso de un paciente varón sin antecedente previo de patología tiroidea que ingresó por coma mixedematoso y desarrolló insuficiencia respiratoria después de la administración endovenosa de midazolam. Tenía 55 años de edad, y una enfermedad de dos semanas caracterizado por letargia, debilidad, hiporexia y cefalea. Los análisis de laboratorio mostraron anemia, hiponatremia severa y niveles elevados de transaminasas y creatinquinasa. TSH elevada y T4 y T3 en niveles muy bajos. Se inició tratamiento con levotiroxina, corticoides endovenosos y solución hipertónica de cloruro de sodio. La evolución fue mala, se colocó un catéter venoso central bajo sedación con midazolam endovenoso para monitoreo hemodinámico, luego del cual, el paciente desarrolló insuficiencia respiratoria, mayor compromiso del sensorio y falleció. En pacientes con hipotiroidismo, el metabolismo del midazolam esta alterado y puede causar insuficiencia respiratoria. (Rev Med Hered 2008; 19:171-174.

  3. Estrategia y resultados de la farmacovigilancia de vacunas desde el Instituto Finlay, 2009

    Directory of Open Access Journals (Sweden)

    Iván E. Cuevas-Valdespino

    2010-08-01

    Full Text Available El objetivo de este trabajo fue mostrar la estrategia y los resultados de la farmacovigilancia desde el Instituto Finlay, como titular de registros sanitarios. Se concretó la biografía de los productos en la etapa de poscomercialización y se examinó el balance riesgo/beneficio. Esto fue posible gracias a convenios con instituciones que permitieron el acceso a bases de datos digitales y auditables, donde se encontró la notificación espontánea de eventos adversos y el cumplimiento de las buenas prácticas, reglamentos y regulaciones de la autoridad reguladora. La minería de datos para la búsqueda de la agrupación de eventos raros e inesperados para un mismo lote o de accidentes, la confección de los informes periódicos de seguridad y la práctica sistemática para completar la información de seguridad solicitada en subpoblaciones y grupos especiales permitió actualizar el perfil de seguridad de las vacunas. Se confirmó que la vacuna antileptospirósica trivalente, la antitifoídica Vi y el toxoide tetánico, presentaron una frecuencia de eventos adversos menor de 0,1 reporte por cada 100.000 dosis administradas, mientras las demás vacunas tuvieron valores entre 1 y 10 por cada 10.000 vacunados. Entre el 80% y 95% de las notificaciones fueron relacionadas causalmente con la vacuna, y solo el 0,89% fueron de severidad grave, casi todas en niños menores de un año. Las manifestaciones generales fueron las que predominaron. Los resultados presentados muestran la importancia que tiene la farmacovigilancia desde la industria para obtener una valiosa información de la seguridad en la aplicación de las vacunas.

  4. Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Mojtaba Vahid Golpayegani

    2012-01-01

    Conclusion: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results.

  5. Comportamiento de las reacciones adversas a los analgésicos y antiinflamatorios no esteroideos notificadas por el Sistema Cubano de Farmacovigilancia en el 2001

    Directory of Open Access Journals (Sweden)

    Giset Jiménez López

    2003-12-01

    Full Text Available Los fármacos analgésicos y antiinflamatorios no esteroideos comparten algunas actividades terapéuticas y efectos colaterales, su mecanismo de acción está mediado por la inhibición de la ciclooxigenasa (COX 1 y 2, enzima encargada de la biosíntesis de prostaglandinas y otros autacoides similares. En la Unidad Coordinadora de Farmacovigilancia se hace un análisis periódico de las sospechas de reacciones adversas notificadas, y en el 2001 se observó que de los 10 fármacos sospechosos de producir mayor número de reacciones adversas el 50 % corresponde al grupo de los analgésicos y antiinflamatorios no esteroideos, que es a su vez uno de los grupos de mayor consumo en el país. Se realiza una descripción del comportamiento de las sospechas de reacciones adversas relacionadas con aspirina, dipirona, indometacina, ibuprofeno, naproxeno, paracetamol y piroxicam, incluyendo severidad, características demográficas y mecanismo fisiopatológico de estas. En el 2001 se recibieron en la Unidad Coordinadora de Farmacovigilancia 16 195 notificaciones que contenían un total de 33 601 reacciones adversas medicamentosas, de las cuales el 21,5 % correspondió a los analgésicos y antiinflamatorios no esteroideos, grupo este más notificado después de los antimicrobianos. Se encontró que las reacciones de mayor gravedad afectaron a los sistemas hematológico, gastrointestinal y cuerpo como un todo; el sexo femenino y el adulto joven fueron los más afectados. Debido a las reacciones notificadas y a la severidad de estas es necesario mantener vigilancia activa sobre dicho grupo farmacológico y realizar una prescripción adecuada por los médicos con el fin de minimizar el riesgo de sufrir reacciones adversas.The analgesics and nonsteroideal antiinflammatory drugs share some therapeutic activities and side effects. Their action mechanism is mediated by the inhibition of cyclooxygenase (COX 1 and 2, an enzime incharge of the biosynthesis of

  6. Aplicación de la minería de datos al Sistema Cubano de Farmacovigilancia Application of data mining to the Cuban Pharmacovigilance System

    Directory of Open Access Journals (Sweden)

    Omar Calzadilla Fernández de Castro

    2007-12-01

    Full Text Available En el año 1999, se crea la Unidad Nacional Coordinadora de Farmacovigilancia, la cual funciona como el órgano técnico-científico que desarrolla la política de vigilancia de seguridad de medicamentos del Ministerio de Salud Pública e integra las actividades de los centros provinciales y de otros programas concertados de farmacovigilancia en un sistema único. Entre sus funciones más relevantes se encuentran la de definir, diseñar y desarrollar los sistemas de información; administrar la base de datos nacional; depurar y validar la información contenida en ella; y realizar y coordinar estudios científicos sobre la seguridad de los medicamentos; así como elaborar informes para las autoridades sanitarias y el Sistema Nacional de Salud. En este sistema existe la necesidad de utilizar herramientas de análisis, por lo que se trazó el objetivo de definir, diseñar y desarrollar los sistemas de tratamiento de la información y administrar la base de datos nacional "VigiBaseCuba". Aplicando una serie de transformaciones, validaciones y la adecuación de la metodología CRISP-DM para la elaboración de proyectos de minería de datos, se conformó la base de datos nacional, en un sistema de gestión de bases de datos relacional con los registros de las notificaciones de sospechas de reacciones adversas a los medicamentos y un proceso de descubrimiento de conocimiento que permite gestionar eficazmente la seguridad de los medicamentos, así como desarrollar aplicaciones para la visualización de las señales de reacciones adversas y su evoluciónIn 1999, The National Coordinating Unit of Pharmacovigilance was created. It works as a scientific and technical agency that develops the drug safety surveillance policy of the Ministry of Public Health, and integrates the activities of the provincial centres and other pharmacovigilance programs in a unique system. Some of its most important functions are to define, design and develop the information

  7. Midazolam for sedation before procedures.

    Science.gov (United States)

    Conway, Aaron; Rolley, John; Sutherland, Joanna R

    2016-05-20

    Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous system (CNS) with rapid onset of action and few adverse effects. The drug can be administered by several routes including oral, intravenous, intranasal and intramuscular. To determine the evidence on the effectiveness of midazolam for sedation when administered before a procedure (diagnostic or therapeutic). We searched the Cochrane Central Register of Controlled Trials (CENTRAL to January 2016), MEDLINE in Ovid (1966 to January 2016) and Ovid EMBASE (1980 to January 2016). We imposed no language restrictions. Randomized controlled trials in which midazolam, administered to participants of any age, by any route, at any dose or any time before any procedure (apart from dental procedures), was compared with placebo or other medications including sedatives and analgesics. Two authors extracted data and assessed risk of bias for each included study. We performed a separate analysis for each different drug comparison. We included 30 trials (2319 participants) of midazolam for gastrointestinal endoscopy (16 trials), bronchoscopy (3), diagnostic imaging (5), cardioversion (1), minor plastic surgery (1), lumbar puncture (1), suturing (2) and Kirschner wire removal (1). Comparisons were: intravenous diazepam (14), placebo (5) etomidate (1) fentanyl (1), flunitrazepam (1) and propofol (1); oral chloral hydrate (4), diazepam (2), diazepam and clonidine (1); ketamine (1) and placebo (3); and intranasal placebo (2). There was a high risk of bias due to inadequate reporting about randomization (75% of trials). Effect estimates were imprecise due to small sample sizes. None of the trials reported on allergic or anaphylactoid reactions. Intravenous midazolam versus diazepam (14 trials; 1069 participants)There was no difference in anxiety (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.39 to 1.62; 175

  8. Cardiac Dysrhythmias With Midazolam Sedation

    OpenAIRE

    Rodrigo, Chandra R.; Rosenquist, Jan B.; Cheng, Chun Ho

    1990-01-01

    A randomized cross-over study was made of 32 young healthy Hong Kong Chinese to compare the incidence and nature of dysrhythmias that occurred during third molar surgery done under local anesthesia, alone or supplemented with midazolam sedation. The incidence of dysrhythmias during surgery was not significantly different during the two procedures. However prior to surgery, 25% of the patients had dysrhythmias during sedation with midazolam. The majority of dysrhythmias were infrequent unifoca...

  9. Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children

    OpenAIRE

    Khatavkar, Sonal S; Bakhshi, Rochana G

    2014-01-01

    Background: T his study was done to compare effects of intranasal midazolam and intranasal midazolam with ketamine for premedication of children aged 1-12 yrs undergoing intermediate and major surgeries. Aims: Midazolam and Ketamine have already been used as premedicants in children. Our aim was to find out advantage of combination of midazolam with ketamine over midazolam by nasal route. Methods: Sixty children of age group 1-12 yrs of American Society of Anesthesiologists (ASA) grade 1 and ...

  10. Ontogeny of midazolam glucuronidation in preterm infants

    NARCIS (Netherlands)

    S.N. de Wildt (Saskia); G.L. Kearns (Greg); D.J. Murry (Darryl); G. Koren (Gideon); J.N. van den Anker (John)

    2010-01-01

    textabstractPurpose: In preterm infants, the biotransformation of midazolam (M) to 1-OH-midazolam (OHM) by cytochrome P450 3A4 (CYP3A4) is developmentally immature, but it is currently unknown whether the glucuronidation of OHM to 1-OH-midazolam glucuronide (OHMG) is also decreased. The aim of our

  11. Ontogeny of midazolam glucuronidation in preterm infants

    NARCIS (Netherlands)

    S.N. de Wildt (Saskia); G.L. Kearns (Greg); D.J. Murry (Darryl); G. Koren (Gideon); J.N. van den Anker (John)

    2010-01-01

    textabstractPurpose: In preterm infants, the biotransformation of midazolam (M) to 1-OH-midazolam (OHM) by cytochrome P450 3A4 (CYP3A4) is developmentally immature, but it is currently unknown whether the glucuronidation of OHM to 1-OH-midazolam glucuronide (OHMG) is also decreased. The aim of our s

  12. Medetomidine-midazolam sedation in sheep.

    Science.gov (United States)

    Raekallio, M; Tulamo, R M; Valtamo, T

    1998-01-01

    Seven sheep were sedated 3 times: with medetomidine (15 micrograms kg-1), with midazolam (0.1 mg kg-1) and with a combination of the drugs. All drugs were administered intravenously. Heart and respiratory rates were measured. Arterial blood samples were collected, and PaO2, PaCO2, pH, haemoglobin concentration and saturation, and base excess were determined. Systolic and mean arterial pressures were recorded before and after the treatment with medetomidine-midazolam. Midazolam increased the time of recumbency induced by medetomidine. After administration of midazolam alone, 4 of the 7 sheep were sedated and the other 3 were excited. Heart rate decreased after both medetomidine and medetomidine-midazolam. One sheep suffered a cardiac arrest after medetomidine-midazolam injection, and it required resuscitation. PaO2 and haemoglobin oxygen saturation decreased after medetomidine, and medetomidine-midazolam caused a marked hypoxaemia. PaCO2 increased after medetomidine, both alone and combined with midazolam, but arterial pH was within the reference values after all drug administrations. Systolic and mean arterial pressures decreased after medetomidine-midazolam. This study indicates that though in sheep midazolam potentiates the sedative effect of medetomidine, the combination of medetomidine and midazolam also reduces the in PaO2 and haemoglobin oxygen saturation more than medetomidine alone. The results indicate that a medetomidine-midazolam combination is unsafe for sheep at the doses studied.

  13. [Effectiveness of intravenous sedation with midazolam-diphenhydramine in patients who are going to perform an magnetic resonance].

    Science.gov (United States)

    Álvarez-Bastidas, Lucía; Sabag-Ruiz, Enrique; Medina-Soto, Alfonso

    2017-01-01

    The requirement of the anesthesiologist for patient care outside the surgical area is constantly increasing. It is an activity that encompasses the different degrees of monitoring, sedation, and anesthesia. To compare the safety and efficacy of midazolam midazolam-diphenhydramine against magnetic resonance with level of sedation on the Ramsay scale. We performed a study in the Instituto Mexicano del Seguro Social Obregon, Sonora, of patients scheduled for cranial magnetic resonance imaging with sedation, during October and December 2013, comparing two groups: midazolam/diphenhydramine against midazolam groups. We included 68 patients, 34 in the experimental group (midazolam-diphenhydramine) versus 34 controls (midazolam). The Ramsay scale showed, in the experimental group, an increased sedation effect resulting in one Ramsay 1, at 10 minutes 2.8 2.8 20 minutes and 30 minutes 2.0. In the control group the basal Ramsay was 1, 2.1 to 10 minutes, 20 minutes and 2.1 to 2.0 at 30 minutes (p = 0.0001). The analysis of heart rate, respiratory, and baseline oxygen saturation, at 10, 20 and 30 minutes, was p = 0.0001 for both groups. The combination of diphenhydramine with intravenous midazolam is safe, with the degree of sedation being better compared with use of midazolam alone, resulting in less failure of sedation during magnetic resonance imaging.

  14. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

    OpenAIRE

    Acworth, J; Purdie, D.; Clark, R

    2001-01-01

    Objectives—This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.

  15. Fentanyl-midazolam vs. midazolam-ketamine regarding patient sedation analgesia for emergency orthopedic procedures

    National Research Council Canada - National Science Library

    Ali Abdolrazaghnejad; Mohsen Banaie

    2017-01-01

    The aim of the present study was to investigate two pharmaceutical groups including fentanyl-midazolam and midazolam-ketamine used as patient seda-tion analgesia for the orthopedic emergency procedures...

  16. The pharmacokinetics of midazolam in man.

    Science.gov (United States)

    Smith, M T; Eadie, M J; Brophy, T O

    1981-03-01

    Midazolam, a new water-soluble benzodiazepine, was administered as: i) 5 mg intravenously, ii) a 10-mg oral solution and iii) a 10-mg oral tablet, to six volunteers whose informed consent had been obtained. Midazolam plasma concentrations were measured using an electron-capture gas-liquid chromatographic assay. After 5-mg intravenous midazolam, subjects fell asleep within 1-2 min and continued to sleep for an average of 1.33 h. After oral midazolam intake (solution or tablets), drowsiness appeared after a average of 0.38 h (range 0.25-0.55 h) and sleep continued for an average of 1.17 h. The time to reach peak plasma midazolam concentration after the 10-mg solution dose (0.37 +/- 0.45 h) did not differ significantly ('t' = 2.04, df = 10, p greater than 0.05) from the time to reach peak plasma midazolam level after the 10-mg tablet dose (0.74 +/- 0.45 h). The terminal half-life, (t 1/2), of midazolam in plasma was 1.77 +/- 0.83 h and there was no significant difference between the mean terminal half-life values obtained for the three midazolam formulations. The mean total clearance (Cl), of midazolam after 5-mg intravenous administration was 0.383 +/- 0.0941 . kg-1 . h-1. The first pass effect, F, determined experimentally (0.36 +/- 0.09) indicated the substantial first pass metabolism of midazolam. The percentage of the midazolam dose excreted unchanged in urine in four subjects during the 0-8-h urine collection interval was very small (0.011%-0.028%).

  17. Midazolam compared with ketamine for invasive procedures

    NARCIS (Netherlands)

    Tamminga, Rienk Y J; Armbrust, Wineke; Kamps, Willem A

    2003-01-01

    The combination of ketamine and topical placebo cream was compared with the combination of midazolam and topical lidocaine-prilocaine cream (EMLA) in 13 children with leukaemia undergoing bone marrow punctures. This double-blind, randomized, crossover study showed that the children prefer midazolam

  18. Midazolam compared with ketamine for invasive procedures

    NARCIS (Netherlands)

    Tamminga, Rienk Y J; Armbrust, Wineke; Kamps, Willem A

    2003-01-01

    The combination of ketamine and topical placebo cream was compared with the combination of midazolam and topical lidocaine-prilocaine cream (EMLA) in 13 children with leukaemia undergoing bone marrow punctures. This double-blind, randomized, crossover study showed that the children prefer midazolam

  19. Relevancia de la farmacovigilancia hospitalaria en la práctica médica actual Importance of pharmacovigilance in current medical practice

    Directory of Open Access Journals (Sweden)

    Marcelo L. Ponte

    2013-02-01

    Full Text Available Las reacciones adversas medicamentosas (RAM generan actualmente una notable morbimortalidad, llegando a representar entre la cuarta y sexta causa de muerte y hasta un 12% de las hospitalizaciones en países desarrollados. Este es, además, un problema creciente. El objetivo del trabajo fue revisar la incidencia de RAM en un hospital de alta complejidad. Se revisó la base de datos del sistema de farmacovigilancia, desde junio de 2008 hasta febrero de 2012. Para determinar la causabilidad de una droga en un evento médico se aplicó el índice de Naranjo de efectos indeseables medicamentosos. Se consideró RAM grave a aquella que provoca la internación, la prolonga, compromete seriamente la vida, genera discapacidad permanente o teratogénesis o induce la muerte. Se detectaron 2420 RAM en este período. 469 (19.38%; IC 95%: 17.80-20.95 fueron serias, principalmente debido a que fueron causa de hospitalización (n = 287. Hubo 14 muertes atribuibles a RAM. Los grupos farmacológicos más frecuentemente asociados a toxicidad fueron drogas cardiovasculares, antibióticos, neuropsiquiátricas y corticoides. Las RAM más frecuentes afectaron al sistema endocrinometabólico, causaron hepatotoxicidad, nefrotoxicidad y farmacodermias. Las causas más frecuentes de hospitalización por RAM fueron infecciones graves asociadas a tratamiento inmunosupresor y hemorragia digestiva por anticoagulación y antiinflamatorios no esteroides. La incidencia de RAM en pacientes hospitalizados y el número de hospitalizaciones por este motivo fue elevado. Las drogas involucradas fueron similares a las comunicadas en la bibliografía internacional, salvo la alta incidencia de RAM relacionadas a inmunosupresores.Adverse drug reactions (ADRs are cause of significant morbi-mortality They are between the fourth and sixth cause of mortality in developed countries and cause nearly 12% of hospitalizations. The objective of this publication was to analyze the incidence of ADRs

  20. Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children

    Directory of Open Access Journals (Sweden)

    Sonal S Khatavkar

    2014-01-01

    Full Text Available Background: T his study was done to compare effects of intranasal midazolam and intranasal midazolam with ketamine for premedication of children aged 1-12 yrs undergoing intermediate and major surgeries. Aims: Midazolam and Ketamine have already been used as premedicants in children. Our aim was to find out advantage of combination of midazolam with ketamine over midazolam by nasal route. Methods: Sixty children of age group 1-12 yrs of American Society of Anesthesiologists (ASA grade 1 and 2 were selected. Group A- midazolam (0.2 mg/kg, Group B- midazolam (0.15 mg/kg + ketamine 1 mg/kg. Both groups received drug intranasally 30 min before surgery in recovery room with monitored anesthesia care. Onset of sedation, sedation score, emotional reaction, intravenous cannula acceptance, and mask acceptance were studied. Statistical Analysis: Unpaired t test and chi square test. Results: Sedation score, anxiolysis, attitude, reaction to intravenous cannulation, face mask acceptance, and emotional reaction were significantly better in midazolam with ketamine group. Intra operatively, in both groups, pulse rate, oxygen saturation, and respiratory rate had no significant difference; also, post operatively, no significant difference was observed in above parameters, post operative analgesia was significantly better in midazolam with ketamine group. Conclusions: Intra nasal premedication allows rapid and predictable sedation in children. Midazolam as well as combination of Midazolam with ketamine gives good level of sedation and comfort. But quality of sedation, analgesia, and comfort is significantly better in midazolam with ketamine group. No significant side effects were observed in both groups.

  1. Comparison of dexmedetomidine versus midazolam for intranasal ...

    African Journals Online (AJOL)

    in children posted for elective surgery: a double-blind, randomised study. Deepak Singlaa* , Gunjan ... Intranasal midazolam as premedication in preschool children was first studied by Wilton ... Material and methods. This double-blind equally ...

  2. Comparison of Oral Midazolam With Intravenous Midazolam for Sedation Children During Upper Gastrointestinal Endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmad Khodadad

    2016-10-01

    Full Text Available Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%, 2 patients were resisted first and then relaxed (3.5% and 55 patients were separated from their parents without any resistance (93%; whereas in IV midazolam group, 8 patients were high resistant (13.3%, 29 patients were relatively resistant (48.3% and 23 patients were separated from their parents without any resistance (38.3% that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.

  3. Comparison of Oral Midazolam With Intravenous Midazolam for Sedation Children During Upper Gastrointestinal Endoscopy.

    Science.gov (United States)

    Khodadad, Ahmad; Aflatoonian, Majid; Jalilian, Rozita; Babaei, Nazanin; Motamed, Farzaneh; Ebrahime Soltani, Alireza; Rasoolzadeh, Behnaz; Motavasselian, Fatemeh; Rezaei, Nima

    2016-09-01

    Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV) midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%), 2 patients were resisted first and then relaxed (3.5%) and 55 patients were separated from their parents without any resistance (93%); whereas in IV midazolam group, 8 patients were high resistant (13.3%), 29 patients were relatively resistant (48.3%) and 23 patients were separated from their parents without any resistance (38.3%) that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.

  4. Midazolam-sirupus, formulation and pharmacodynamic efficacy

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    K. Goracinova

    2002-04-01

    Full Text Available Due to its pharmacokinetic and pharmacodynamic properties (sedation, amnesia and relief of anxiety Midazolam has become a comm only used agent for conscious sedation of children before diagnostic or therapeutic procedure or before induction of anesthesia. Con sidering the advantage of oral administration to avoid the additional trauma of starting an IV in the child, and the fact that there is no ad equate dosage form (Midazolam - Syrupus on the drug market in our country, the aim of the presented work was to formulate syrupus using syrupus b ase/aqueous solution of viscosity enhancer - HPMC, in combination with suitable sweetener, flavor, and preservatives, and to evaluate its q uality and stability. The pharmacodynamic efficacy/sedative effect of Midazolam HCl - Syrupus formulation was evaluated in 33 pediatric patients comp aring this with the efficacy of intramuscularly administered Midazolam HCl (35 pediatric patients in accordance with the Ramsay scale for analgosedation. The formulation manifested good quality in respect to physical properties, physico-chemical parameters (pH value, relative dens ity, drug content, ingredients content antimicrobial efficacy and microbiological quality according to Ph Eur 3. In the conditions chara cteristic of the second (II climate zone, the dosage form was stable for four months. The sedative effect of orally administered Midazolam was manifested in a period necessary for surgical premedication (30 - 45 min. The majority of patients (71% entered the second phase on the Ramsa y scale, when Midazolam was administered in a dose of 0.40 mg/kg.

  5. Midazolam sedation for percutaneous liver biopsy.

    Science.gov (United States)

    Alexander, J A; Smith, B J

    1993-12-01

    Control of patient respiration is needed to safely perform percutaneous liver biopsy (PLB) and may be adversely affected by sedation. The purpose of this study was to evaluate the safety of PLB with intravenous midazolam and to evaluate patient acceptance of PLB with and without sedation. Two hundred seventeen consecutive patients underwent 301 percutaneous liver biopsies. One hundred fifty-one of the biopsies were done after the patients were sedated with intravenous midazolam immediately before the biopsy. The last 61 patients were questioned after the biopsy to evaluate the discomfort of the procedure, their memory of the procedure, and their willingness to undergo another PLB. The major complication rate was similar in the midazolam-treated (0.7%) and untreated (0.7%) groups. The midazolam-treated patients had a numerically lower mean pain score (1.5 +/- 0.4 vs 4.0 +/- 0.7) (mean +/- SEM) (P = 0.07) and significantly lower mean memory score (4.8 +/- 0.7 vs 9.9 +/- 0.1) (P < 0.01) than the untreated patients. The treated and untreated groups had similar mean willingness for repeat PLB scores (9.3 +/- 0.3 vs 9.1 +/- 0.6). We conclude that: (1) there is no increased risk of PLB with midazolam and (2) patients have less memory of the procedure with midazolam.

  6. [Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain].

    Science.gov (United States)

    Raspall-Chaure, Miquel; Martinez-Bermejo, Antonio; Sanchez-Carpintero, Rocío; Ruiz-Falco Rojas, M Luz; Verdu-Perez, Alfonso; Smeyers-Dura, Patricia; Camino-Leon, Rafael; Sanmarti, Francesc X; Santos-Borbujo, José; Pico, Gustavo; Blanco-Barca, Oscar; Cebollero, M Antonia

    2014-06-01

    Introduccion. El tratamiento de las crisis epilepticas prolongadas requiere disponer de una medicacion de rescate comoda, segura y efectiva. Actualmente, el tratamiento estandar en la comunidad es el diacepam rectal. La introduccion de una solucion bucal de midazolam abre una perspectiva nueva en el tratamiento. Objetivo. Evaluar el coste-efectividad del midazolam bucal respecto al diacepam rectal para los niños con un diagnostico de epilepsia que presentan crisis convulsivas prolongadas en la comunidad en España. Materiales y metodos. Modelo coste-efectividad desde la perspectiva del Sistema Nacional de Salud (SNS) español, con resultados presentados en terminos de costes y años de vida ajustados por calidad. Los datos se obtuvieron de varias fuentes, incluidas las estimaciones de efectividad clinica de un ensayo clinico, de un panel Delphi en España y de una encuesta nacional a padres de niños con epilepsia para determinar las practicas actuales. Resultados. El tratamiento con midazolam bucal produce un ahorro de costes en comparacion con el diacepam rectal. El ahorro para el SNS español es de 5.484 euros por paciente al año. El tratamiento con midazolam bucal ofrece una mejora en la calidad de vida relacionada con la salud. Esto, unido al ahorro de costes, hace que el midazolam bucal sea dominante frente al diacepam rectal en todos los escenarios examinados. Conclusion. Los resultados del modelo muestran que el midazolam bucal es mas coste-efectivo que el diacepam rectal debido a una reduccion en la necesidad de llamadas a la ambulancia y estancias en el hospital, asi como a una mejora en la calidad de vida relacionada con la salud.

  7. Midazolam and pentobarbital for refractory status epilepticus.

    Science.gov (United States)

    Holmes, G L; Riviello, J J

    1999-04-01

    Status epilepticus, a serious, life-threatening emergency characterized by prolonged seizure activity, occurs most commonly in pediatric patients. Although initial therapies with agents such as diazepam, phenytoin, or phenobarbital generally terminate seizure activity within 30-60 minutes, patients with refractory status epilepticus (RSE) lasting longer require additional intervention. High-dose pentobarbital has been the most commonly prescribed agent for the management of RSE in children; however, midazolam has emerged as a new treatment option. This review compares the use of midazolam with pentobarbital in published reports of pediatric RSE. Both drugs effectively terminated refractory seizure activity, although pentobarbital use was complicated by hypotension, delayed recovery, pneumonia, and other adverse effects. Midazolam use was effective and well tolerated, affirming its value in pediatric RSE management.

  8. [Midazolam sedation in the general dental practice].

    Science.gov (United States)

    Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

    1994-03-01

    The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

  9. Epileptic fits under intravenous midazolam sedation.

    Science.gov (United States)

    Robb, N D

    1996-09-07

    A case is presented of a patient who suffered from recurrent epileptic fits while being treated under intravenous sedation with midazolam. Those using sedation are advised to beware of the patient who gives a history of fits being provoked in the dental environment.

  10. Midazolam: newcomer to the benzodiazepine family.

    Science.gov (United States)

    Karb, V B

    1989-02-01

    The development of midazolam has been a nice addition to the list of drugs used for preprocedure or preoperative conscious sedation. Like other CNS depressants, it has potentially serious adverse effects, but with careful use, provides the practitioner with another drug useful for easing a patient through a difficult procedure or surgery.

  11. Pharmacokinetics and pharmacodynamics of midazolam administered as a concentrated intranasal spray. A study in healthy volunteers.

    NARCIS (Netherlands)

    Knoester, P.D.; Jonker, D.M.; Hoeven, R.T. van der; Vermeij, T.A.; Edelbroek, P.M.; Brekelmans, G.J.; Haan, G.J. de

    2002-01-01

    AIMS: To investigate the pharmacokinetic and pharmacodynamic profile of midazolam administered as a concentrated intranasal spray, compared with intravenous midazolam, in healthy adult subjects. METHODS: Subjects were administered single doses of 5 mg midazolam intranasally and intravenously in a cr

  12. A COMPARISON OF MIDAZOLAM AND KETAMINE PLUS MIDAZOLAM COMBINATION AS AN ORAL PREMEDICANT IN PAEDIATRIC PATIENTS

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    Krishna Prabu

    2014-08-01

    Full Text Available INTRODUCTION: Effective premedication in pediatric patients posted for elective surgeries allays patients’ anxiety and reduces risk of post-operative behavioral problems. Oral midazolam and oral ketamine are tried in different doses as pediatric premedicant, but addition of 3mg/kg of oral ketamine with 0.5 mg/kg of oral midazolam resulted in better premedication when compared to oral midazolam 0.5mg/kg or oral ketamine 6mg/kg given alone. MATERIAL AND METHODS: 60 healthy children under 1-8 yrs. age group posted for elective surgeries chosen for this study were randomly divided into two groups of 30 each. Double blinding was done using sealed envelope technique to prevent observer bias. Children with other co-existing illnesses were excluded from the study. Group KM received Ketamine 3 mg/kg and midazolam 0.5 mg/kg + atropine 20 µg/kg (oral route and Group M received midazolam 0.5 mg/kg and atropine 20 µg/kg (oral route 30 minutes before proposed induction time. Sedation score, anxiolysis score, parental separation and mask tolerance was assessed in all the patients 30 minutes after administration of the drug. RESULTS: The data collected was analyzed using SPSS statistical software. There was a statistically significant increase in sedation score at 15 and 30 minutes in group KM compared to group M. Parental separation at 30 minutes is peaceful in 30 children (100% in group KM compared to 24 children (80% in group M. CONCLUSION: The oral ketamine and midazolam combination produces significantly better anxiolysis, sedation, parental separation and mask tolerance, without hemodynamic alteration, when compared to oral midazolam (0.5mg/kg given alone.

  13. Aminophylline Fails to Reverse Conscious Sedation with Midazolam in Dentistry

    OpenAIRE

    Rodrigo, Chandra R.; Rosenquist, Jan B.

    1986-01-01

    A double blind, randomized crossover study investigated whether aminophylline reverses the conscious sedation with midazolam in dentistry to result in quicker clinical recovery than when midazolam is used alone. Twenty-five patients between 17-30 years of age (ASA Grade 1) were sedated with midazolam for bilateral third molar extractions, one side being operated on one visit. Aminophylline or normal saline was given at the end of the surgical procedure on one visit and the alternative during ...

  14. Observations on some cardiopulmonary effects of midazolam, xylazine and a midazolam / ketamine combination in the goat

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    G.F. Stegmann

    1999-07-01

    Full Text Available Xylazine, midazolam and a midazolam / ketamine combination were administered to 6 goats in a randomised 3-way block design. All goats received all treatments with at least a 7-day interval between treatments. Statistically significant (P < 0.05 changes were observed in some of the measured cardiopulmonary variables for xylazine and midazolam/ ketamine. Xylazine administration resulted in statistically significant decreases in minute volume, arterial partial pressure of oxygen, heart rate andmeanarterial blood pressure. The increase in arterial partial pressure of carbon dioxide was not statistically significant. For the midazolam / ketamine combination, the decrease in tidal volume was statistically significant, but not the decrease in minute volume and increase in arterial partial pressure of carbon dioxide. The decrease in the arterial partial pressure of oxygen was also statistically significant. The mean arterial blood pressure for the combination was statistically significantly higher compared to xylazine. The changes in cardiopulmonary variables after midazolam administration were not statistically significant, such as tidal and minute volume, arterial partial pressure of oxygen and carbon dioxide. However, clinically significant effects such as hypoventilation and hypoxia were observed after its administration. The change in mean arterial blood pressure was minimal.

  15. [Use of midazolam for refractory status epilepticus in children].

    Science.gov (United States)

    Lampin, M-E; Dorkenoo, A; Lamblin, M-D; Botte, A; Leclerc, F; Auvin, S

    2010-01-01

    Morbidity and mortality are high in children with refractory status epilepticus (RSE). Here, we assess the efficacy of midazolam for RSE in children. This was a retrospective analysis of 29 children admitted to the Lille University Hospital pediatric intensive care unit (PICU) for RSE between May 2006 and July 2008. The onset of the study corresponded with a new therapeutic protocol applied in the PICU for RSE where midazolam was proposed as the first-line treatment (bolus ten continuous infusion until control) to be replaced by thiopenthal in case of failure. We recorded 29 patients with RSE during the study period: 26 were treated with midazolam, including two where midazolam replaced thiopenthal because of hypotension. Midazolam successfully controlled RSE in 58% of patients. Mean delay to cessation of RSE was 48+/-65 minutes. Hypotension was observed in 8% of midazolam-treated patients and 71% of thiopenthal-treated patients. Overall mortality was 15% (4/26). Two deaths occurred long after the cessation of RSE. None of the deaths occurred in midazolam-treated patients. Midazolam is an efficient treatment for RSE in children. Morbidity and mortality appear to be lower with midazolam compared with other antiepileptic drugs used for the treatment of RSE.

  16. Sedation for transesophageal echocardiography: comparison of propofol, midazolam and midazolam-alfentanil combination

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    Huseyin Toman

    2016-02-01

    Full Text Available Aim The administration of trans esophageal echocardiography (TEE may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions. Methods This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 μg/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS, modified Aldrete Scoring (MAS, recovery time and duration of stay in the hospital. Results In the group P additional dose requirements were greater (p<0.05, as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05. On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05. Conclusion During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone.

  17. Reemergence of stroke deficits with midazolam challenge.

    Science.gov (United States)

    Lazar, Ronald M; Fitzsimmons, Brian-Fred; Marshall, Randolph S; Berman, Mitchell F; Bustillo, Maria A; Young, William L; Mohr, J P; Shah, Jinesh; Robinson, Julie V

    2002-01-01

    Patients who have sustained a neurological injury and then improved may experience transient reemergence of their syndromes when given benzodiazepines. As a step toward assessing whether neurotransmitter systems underlie poststroke clinical improvement, we selected midazolam, a gamma-aminobutyric acid(A) (GABA(A)) agonist, for systemic administration to measure general or stroke-specific effects in patients. Eight patients with image-verified stroke (5 with left-sided and 3 with right-sided cerebral lesions) participated. The strokes had occurred from 7 days to 6 years earlier, with patients showing clinical improvement from their initial syndromes. Each patient underwent baseline testing for motor function, aphasia, and left hemispatial neglect, after which intravenous midazolam was delivered until mild drowsiness was detected. Patients were tested during this period and again after 2 hours when sedation had dissipated. After the administration of midazolam, the 5 patients with left hemisphere stroke demonstrated reemergence or worsening of their initial right hemiparesis and aphasia but showed no left neglect. The 3 patients with right cerebral stroke showed reemergence of left hemiparesis and left visual field neglect but no aphasia. All patients returned to baseline after 2 hours. Under conditions of light sedation, patients whose initial stroke syndrome had substantially improved clinically showed transient reemergence of their initial focal syndrome. These data suggest a possible role for GABA(A)-mediated neurochemical mechanisms in poststroke improvement and sensitivity to medication effects.

  18. Propofol Reduces the Distribution and Clearance of Midazolam

    NARCIS (Netherlands)

    Lichtenbelt, Bart Jan; Olofsen, Erik; Dahan, Albert; van Kleef, Jack W.; Struys, Michel M. R. F.; Vuyk, Jaap

    2010-01-01

    BACKGROUND: Midazolam, at sedative levels, increases blood propofol concentrations by 25%. We evaluated the reverse interaction and determined the influence of propofol on the pharmacokinetics of midazolam. METHODS: Eight healthy male volunteers were studied on 2 occasions in a random crossover mann

  19. Propofol Reduces the Distribution and Clearance of Midazolam

    NARCIS (Netherlands)

    Lichtenbelt, Bart Jan; Olofsen, Erik; Dahan, Albert; van Kleef, Jack W.; Struys, Michel M. R. F.; Vuyk, Jaap

    BACKGROUND: Midazolam, at sedative levels, increases blood propofol concentrations by 25%. We evaluated the reverse interaction and determined the influence of propofol on the pharmacokinetics of midazolam. METHODS: Eight healthy male volunteers were studied on 2 occasions in a random crossover

  20. Midazolam and amplitude-integrated EEG in asphyxiated full-term neonates

    NARCIS (Netherlands)

    van Leuven, K; Groenendaal, F; Toet, MC; Schobben, AFAM; Bos, SAJ; de Vries, LS; Rademaker, CMA

    2004-01-01

    Aim: In the present, prospective study, the relation between the levels of midazolam, its two active metabolites-1-hydroxy-midazolam (OH-midazolam) and 1-hydroxy-midazolam-glucuronide (glumidazolam)-and the aEEG were examined. Patients and methods: Fifteen full-term neonates with seizures due to hyp

  1. Parametric evaluation of methotrimeprazine-midazolam-ketamine and methotrimeprazine-midazolam-ketamine-xylazine combination in dogs

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    Santos Gustavo José Von Glehn dos

    2006-01-01

    Full Text Available PURPOSE: To evaluate the parameters of dogs anesthetized by different dissociative drugs protocols through continuous intravenous infusion. METHODS: Thirty healthy dogs of both sexes were assigned randomly to three groups (G1, G2, and G3. G1 was administered with methotrimeprazine as a pre-anesthetic medication, intravenously midazolam-ketamine as bolus for induction and midazolam-ketamine by continuous intravenous infusion for a 60 minute-period of maintenance. G2: the same as for G1. plus an increase in the midazolam dose during maintenance. G3: the same treatment as for G2, plus the addition of xylazine during maintenance. Immediately after induction the anesthetic maintenance started, and measures were taken 15 minutes after pre-medication, at 10 minutes intervals, during maintenance (M0 to M7. RESULTS: Bradycardia, atrioventricular blockage, bradypnea and hypoxemia were shown in G3. G1 and G2 showed a slight hypotension only. CONCLUSION: There were some advantages by using the continuous intravenous via: no parameters oscillation and reduction in the anesthetic recovery period. The increase in midazolam dose brought about little parametric variations which were greater when xylazine was used, with a consequent hypoxemia, bradyarrhytmia, and decrease in respiratory frequency and minute volume.

  2. EcoDopplercardiografia em coelhos: uso de midazolam e midazolam associado à cetamina

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    E.F. Silva

    2011-12-01

    Full Text Available O uso de animais como modelos experimentais muitas vezes exige a administração de sedativos ou anestésicos, particularmente quando se trata de avaliação ecoDopplercardiográfica de coelhos. No entanto, existem poucas informações sobre os protocolos e seus efeitos nestes parâmetros. Diante deste contexto, foram utilizados 20 coelhos Nova Zelândia machos, com cinco meses e 3,2kg, distribuídos em dois grupos de 10 animais cada: G1 - maleato de midazolam associado ao cloridrato de cetamina, e G2 - maleato de midazolam. Compararam-se o efeito dos dois protocolos sob os índices funcionais do ventrículo esquerdo e os fluxos valvares, e observaram-se menores valores de frequência cardíaca e da fração de ejeção e maiores valores de diâmetro do ventrículo esquerdo na sístole, de volume sistólico final do ventrículo esquerdo e de diâmetro aórtico no grupo que recebeu apenas maleato de midazolam (G2. Concluiu-se que, o maleato de midazolam apresentou-se mais eficaz, pois causou boa sedação nos animais, permitindo a realização de ecoDopplercardiogramas de qualidade e efeitos limitados no sistema cardiovascular.

  3. Comparison Effect of Midazolam Alone and Midazolam Combined with Ketamine in Bone Marrow Aspiration Pain in Children

    Science.gov (United States)

    Mahmoudi Nesheli, H

    2015-01-01

    Background This study aimed to compare sedative and analgesic effects of oral Midazolam and Ketamine on Bone Marrow aspiration (BMA) and Lumbar Puncture (LP). Material and Methods This study was a randomized clinical trial and was performed in Amirkola Hospital in north of Iran, Babol during 2011 and 2012 .The study population consisted of 40 patients who underwent the first time of diagnostic BMA for any reason, patients were divided randomly in two groups: Oral Midazolam and combined Oral Midazolam and Ketamine. Each group consisted of patients with age of 3-7 years and over 7 years .Two methods of pain status and soothing were evaluated through CAMFORT scale checklist based on MAGNUSON National Institutes of Health Medical Center. Statistical analyses were done by Spss v.19. Results In our study, 17(42.5%) and 23(57.5%) were female and male, respectively. 28(70%) patients were aged between 3 and 7 years and 13(30%) older than 7 years. The obtained findings revealed that the difference between Midazolam sedation and combination of Midazolam and Ketamine sedation was significant (P= 0.00). The sedation in older patients was more than young patients in combination of Midazolam and Ketamine group. (P= 0.22). Conclusion These findings showed that Ketamine and Midazolam combination had more efficacy than Midazolam alone for decreasing pain and sedation. PMID:26705451

  4. Intranasal midazolam administration enhances amnesic effect in rats.

    Science.gov (United States)

    Kadono, Takao; Kawano, Takashi; Yamanaka, Daiki; Tateiwa, Hiroki; Urakawa, Manami; Locatelli, Fabricio M; Yokoyama, Masataka

    2016-06-01

    Intranasal (i.n.) administration of midazolam has been shown to be effective and safe for its sedative, anxiolytic, and anticonvulsant effects. However, there has been no investigation on the influence of i.n. administration on midazolam-induced anterograde amnesia. In addition, although the potential of direct drug delivery from the nose to the central nervous system (CNS) has recently become a topic of great interest, it remains unclear whether this pathway is also involved after i.n. midazolam. In this study, we examined the efficacy and the underlying mechanism of i.n. administration compared with intramuscular (i.m.) administration on midazolam-induced amnesia in rats. Equivalent doses of 0.6 mg/kg midazolam were administered via either the i.m or the i.n. route. Anterograde amnesia was assessed by a contextual/cued fear conditioning test. Each animal was conditioned 20 min after drug administration and then tested for a freezing response 24 h later. Midazolam administration by either route produced a similar level of light sedation (minimum spontaneous activity). However, i.n. administration of midazolam induced significantly less freezing behavior compared with i.m. midazolam. Furthermore, in rats with disrupted electrical input from the olfactory epithelium after an olfactotoxicant 3-methylindole administration, the i.n.-mediated enhanced amnesic effect of midazolam was not observed. Our findings indicate that i.n midazolam could probably generate olfactory signals to the brain via benzodiazepine receptors and, compared with i.m. administration, can produce a more significant amnesic effect without alteration in sedative levels. Further clinical studies are warranted.

  5. Coma mixedematoso y midazolam: Reporte de caso.

    OpenAIRE

    PINTO VALDIVIA, Miguel; Vásquez Kunze, Sergio; Pinto Valdivia, José Luis; VILLENA CHÁVEZ, Jaime

    2012-01-01

    Se reporta el caso de un paciente varón sin antecedente previo de patología tiroidea que ingresó por coma mixedematoso y desarrolló insuficiencia respiratoria después de la administración endovenosa de midazolam. Tenía 55 años de edad, y una enfermedad de dos semanas caracterizado por letargia, debilidad, hiporexia y cefalea. Los análisis de laboratorio mostraron anemia, hiponatremia severa y niveles elevados de transaminasas y creatinquinasa. TSH elevada y T4 y T3 en niveles muy bajos. Se in...

  6. Cytotoxic Effects of Intranasal Midazolam on Nasal Mucosal Tissue.

    Science.gov (United States)

    Ozbay, I; Kucur, C; Değer, A; Ital, I; Kasim, Cayci M; Oghan, F

    2015-09-01

    The aim of this experimental study was to investigate the cytotoxic effects of intranasal midazolam on nasal mucosal tissue in rats. Forty healthy rats were randomly divided into 5 groups. Group 1 (n = 8) was the control group, group 2 (n = 8) received intranasal saline, group 3 (n = 8) received intranasal midazolam, group 4 (n = 8) received intraperitoneal saline, and group 5 received intraperitoneal midazolam (n = 8). Midazolam and saline were administered via intraperitoneal and intranasal routes at doses of 200 μg/kg. Nasal septal mucosal stripe tissues were removed at the 6th hour. All materials were evaluated according to Ki67 and p53 staining to evaluate proliferation and apoptosis, respectively, and hemotoxylin and eosin staining was performed for histopathology evaluation. Ki67 values and inflammation in group 3 were statistically higher compared to group 1, group 2, and group 4. P53 values in group 3 were statistically higher compared to group 1. Assessment of subepithelial edema between group 3 and the other groups revealed no statistically significant differences. Assessment of cilia loss between group 3 and group 1, group 2, and group 4 revealed no statistically significant difference. The evaluation of goblet cell loss between group 3 and group 1 revealed a statistically significant difference. Intranasal midazolam had adverse effects on nasal mucosa. However, intranasal midazolam is as safe as systemic midazolam administration with respect to nasal mucosa.

  7. The use of Midazolam as an Intranasal Sedative in Dentistry.

    Science.gov (United States)

    Greaves, Anwen

    2016-01-01

    The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner. Randomised Control trials using intranasal sedation in children have shown the technique to be safe and effective in secondary care for dental procedures at concentrations varying from 0.2 mg/kg to 0.5 mg/kg. A combined technique of intranasal midazolam (to facilitate cannulation) and intravenous midazolam is used for adults with moderate to severe learning disabilities. This has revolutionised dental treatment for this group of patients as treatment under General Anaesthesia (GA) may be avoided. Intranasal delivery of midazolam is emerging as a significant tool in our dental armamentarium for the treatment of anxious children, phobic adult patients and patients with learning disabilities.

  8. Role of neurosteroids in the anticonvulsant activity of midazolam

    Science.gov (United States)

    Dhir, Ashish; Rogawski, Michael A

    2012-01-01

    BACKGROUND AND PURPOSE Midazolam is a short-acting benzodiazepine that is widely used as an i.v. sedative and anticonvulsant. Besides interacting with the benzodiazepine site associated with GABAA receptors, some benzodiazepines act as agonists of translocator protein (18 kDa) (TSPO) to enhance the synthesis of steroids, including neurosteroids with positive modulatory actions on GABAA receptors. We sought to determine if neurosteroidogenesis induced by midazolam contributes to its anticonvulsant action. EXPERIMENTAL APPROACH Mice were pretreated with neurosteroid synthesis inhibitors and potentiators followed by midazolam or clonazepam, a weak TSPO ligand. Anticonvulsant activity was assessed with the i.v. pentylenetetrazol (PTZ) threshold test. KEY RESULTS Midazolam (500–5000 µg·kg−1, i.p.) caused a dose-dependent increase in seizure threshold. Pretreatment with the neurosteroid synthesis inhibitors finasteride, a 5α-reductase inhibitor, and a functional TSPO antagonist PK 11195, reduced the anticonvulsant action of midazolam. The anticonvulsant action of midazolam was enhanced by the neurosteroidogenic drug metyrapone, an 11β-hydroxylase inhibitor. In contrast, the anticonvulsant action of clonazepam (100 µg·kg−1) was reduced by finasteride but not by PK 11195, indicating a possible contribution of neurosteroids unrelated to TSPO. CONCLUSION AND IMPLICATIONS Enhanced endogenous neurosteroid synthesis, possibly mediated by an interaction with TSPO, contributed to the anticonvulsant action of midazolam. Enhanced neurosteroidogenesis may also be a factor in the actions of other benzodiazepines, even those that only weakly interact with TSPO. PMID:22014182

  9. Atención Farmacéutica: dispensación en la Farmacia Comunitaria desde la Farmacovigilancia

    OpenAIRE

    2015-01-01

    La evolución de la profesión farmacéutica en las últimas décadas otorga al farmacéutico comunitario una responsabilidad asistencial en la salud de los pacientes. La finalidad de la Atención Farmacéutica es proporcionar al paciente una terapia efectiva y, sobre todo, segura. La seguridad del paciente es una prioridad en la actuación sanitaria. El acto de dispensación es la actuación profesional del farmacéutico comunitario por el cual este entrega el medicamento al paciente o a su cuidador. Es...

  10. Periodic cardiovascular and ventilatory activity during midazolam sedation.

    Science.gov (United States)

    Galletly, D C; Williams, T B; Robinson, B J

    1996-04-01

    We have examined the effects of sedation with midazolam 0.1 mg kg-1 and reversal with flumazenil 0.5 mg on beat-to-beat heart rate (HR) variability (HRV), systolic arterial pressure (SAP), finger photoplethysmograph amplitude (PLA) and impedence pneumography in eight volunteers. With the onset of sedation there was a small decrease in SAP and increase in HR (ns). Spectral analysis of the HR time series showed reductions in the proportion of power in the high (> 0.15 Hz) frequency "ventilatory" band consistent with midazolam causing vagolysis. During sedation, low frequency (midazolam sedation were reversed by administration of flumazenil.

  11. Upper airway obstruction during midazolam sedation: modification by nasal CPAP.

    Science.gov (United States)

    Nozaki-Taguchi, N; Isono, S; Nishino, T; Numai, T; Taguchi, N

    1995-08-01

    We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to midazolam sedation for spinal anaesthesia.

  12. Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study : Midazolam plasma concentration after anesthesia premedication.

    Science.gov (United States)

    Steiner, C; Steurer, M P; Mueller, D; Zueger, M; Dullenkopf, A

    2016-10-24

    Midazolam is commonly used as a pre-anesthesia anxiolytic. It`s elimination may not be fast enough for short procedures. In orally premedicated patients we obtained midazolam plasma concentrations at the end of surgical procedures and compared those to concentrations at anesthesia induction. The study was conducted prospectively with consent of the local ethics committee (Ethikkomission Kanton Thurgau, Switzerland) and carried out with written informed consent of each patient. Female patients aged 20 to 60 years undergoing elective procedures with general anesthesia were included, and were divided in two groups according to the planned surgical time: group S (Midazolam po as premedication. Blood samples were drawn at anesthesia induction, and at the end of surgery. Data were compared with t-test (independent samples; significance level p midazolam was not detectable in any samples. Time of premedication to the 1st blood sample was not statistically different between groups, neither were Midazolam plasma levels at this time point (p = 0.94). None of the patients from group L (n = 24), but five patients in group S (n = 22) did have a higher plasma level of Midazolam at the end of the case compared to the beginning. The elimination half-life of oral Midazolam can lead to higher plasma levels at the end of a short procedure compared to those at induction of anesthesia. German Clinical Trials Register (Deutsches Register Klinischer Studien), DRKS00005429 ; date of registration 3(rd) January 2014.

  13. [Optimal dose of midazolam as premedicant for combined spinal and epidural anesthesia with midazolam sedation].

    Science.gov (United States)

    Tabuchi, Y

    1992-04-01

    Sixty patients who underwent simple total hysterectomy under combined spinal and epidural anesthesia with midazolam sedation, were the subjects of a randomized double-blind comparison of intramuscular midazolam 4, 4.5 and 5 mg, and a dose determined by body weight as premedicants. Similar changes in arterial pressure and heart rate were observed. Furthermore sedation and the value of pulse oximetry on arrival were the same. Besides half the patients were amnesic during the procedure of regional approach. However the dose of premedicant was inversely correlated with the maintenance dose. The reduction of pulse oximetry reading on the induction was smaller, while the requirement of vasopressor occurred earlier following the larger dose of premedicant. In spite of the slower induction, the fall of pulse oximetry reading did not decrease. One hour after incision, the reduction of PaO2 was not dose related. In addition count of leucocyte and the level of blood glucose were unchanged. Premedicant determined by body weight was not correlated with the induction dose and amnesic effect. Our findings suggest midazolam 5 mg intramuscularly is the more preferable dose, but careful attention on arterial pressure is required.

  14. The safety and tolerability of intranasal midazolam in epilepsy.

    Science.gov (United States)

    Mula, Marco

    2014-07-01

    Midazolam is a short-acting benzodiazepine that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage of being water-soluble, with a rapid onset of action and it can be administered orally or intranasally, implementing an early intervention at the pre-hospital setting. This article aims to provide an overview of intranasal midazolam in the acute management of epileptic seizures. Available data suggest that midazolam 0.2 mg/kg is as effective as diazepam 0.5 mg/kg, especially in children with febrile or afebrile seizures. Local mucosal irritation seems to occur in less than one-third of cases while serious side effects such as respiratory depression in about 1%. Future studies need to be focused on adults and optimized technologies for intranasal delivery. Moreover, comparisons with buccal midazolam are warranted.

  15. Long-term intrathecal administration of midazolam and clonidine

    NARCIS (Netherlands)

    Borg, PAJ; Krijnen, HJ

    1996-01-01

    Objective: To determine the clinical usefulness of the long-term intrathecal administration of midazolam and clonidine in patients with refractory neurogenic and musculoskeletal pain. Setting: Pain Centre, Academic Hospital Groningen, Groningen, The Netherlands. Patients: Four patients with chronic

  16. Long-term intrathecal administration of midazolam and clonidine

    NARCIS (Netherlands)

    Borg, PAJ; Krijnen, HJ

    Objective: To determine the clinical usefulness of the long-term intrathecal administration of midazolam and clonidine in patients with refractory neurogenic and musculoskeletal pain. Setting: Pain Centre, Academic Hospital Groningen, Groningen, The Netherlands. Patients: Four patients with chronic

  17. [Administration of intravenous sedation with midazolam by dentists is unsafe].

    Science.gov (United States)

    Broers, D L M; Plat, J; de Jongh, A; Zuidgeest, T G M; Blom, H C C M; Kraaijenhagen, A E; Pieterse, C M; Bildt, M M

    2015-03-01

    In the December issue of the Nederlands Tijdschrift voor Tandheelkunde (Dutch Journal of Dentistry) in 2014, an article was devoted to the use of light sedation with midazolam by dentists. A number of dentists who are active in the area of Special Dentistry (anxiety management, care of the disabled) and a anesthesiologist offer a response to the article and argue that the administration of intravenous sedation with midazolam by dentists is unsafe.

  18. Midazolam-induced acute dystonia reversed by diazepam

    Directory of Open Access Journals (Sweden)

    Mustafa Komur

    2012-01-01

    Full Text Available Midazolam can induce acute dystonia in childhood. We report the development of acute dystonia in a 6-year-old girl after receiving midazolam as a sedative. Dystonic contractions persisted despite flumazenil and biperiden lactate injections and the patient was treated with diazepam. Acute dystonia was rapidly abolished after the administration of diazepam intravenously. Diazepam may be an effective treatment option in patients who are unresponsive to flumazenil.

  19. Midazolam-induced acute dystonia reversed by diazepam.

    Science.gov (United States)

    Komur, Mustafa; Arslankoylu, Ali Ertug; Okuyaz, Cetin

    2012-07-01

    Midazolam can induce acute dystonia in childhood. We report the development of acute dystonia in a 6-year-old girl after receiving midazolam as a sedative. Dystonic contractions persisted despite flumazenil and biperiden lactate injections and the patient was treated with diazepam. Acute dystonia was rapidly abolished after the administration of diazepam intravenously. Diazepam may be an effective treatment option in patients who are unresponsive to flumazenil.

  20. Midazolam-induced acute dystonia reversed by diazepam

    OpenAIRE

    2012-01-01

    Midazolam can induce acute dystonia in childhood. We report the development of acute dystonia in a 6-year-old girl after receiving midazolam as a sedative. Dystonic contractions persisted despite flumazenil and biperiden lactate injections and the patient was treated with diazepam. Acute dystonia was rapidly abolished after the administration of diazepam intravenously. Diazepam may be an effective treatment option in patients who are unresponsive to flumazenil.

  1. Midazolam: Review of a Versatile Agent for Use in Dentistry

    OpenAIRE

    1987-01-01

    Midazolam is a relatively new benzodiazepine that is widely used in both medicine and dentistry. Its multiplicity of uses makes it unique among the benzodiazepines, and its water solubility and lack of active metabolites give it distinct advantages over diazepam. This paper reviews the clinical pharmacology of midazolam, provides comparison with diazepam and presents current information regarding its indications, limitations, advantages, disadvantages, methods of administration and precaution...

  2. IV ATP potentiates midazolam sedation as assessed by bispectral index.

    Science.gov (United States)

    Sakurai, Satoru; Fukunaga, Atsuo; Ichinohe, Tatsuya; Kaneko, Yuzuru

    2014-01-01

    In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5'-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions.

  3. SUBLINGUAL BUPRENORPHINE VS MIDAZOLAM FOR PREMEDICATION IN CHILDREN

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    V.A HASANI

    2000-03-01

    Full Text Available Background. Preanesthetic medication may reduce the risks of adverse psychological and physiological sequel of induction in children. Administration of premedication by sublingual route may provide the best compromise because of relatively rapid absorption without causing pain. In this study sedative and anxitolytic effects of sublingual midazolam and buprenorphine in children were compared. Methods. In a randomized, controlled, double blind clinical trial, one hundred and fifty children aged between 4 to 10 years in first or second class of ASA scheduled for adenotonsillectomy were divided in three equal groups. These groups recieved sublingual bupronorphine 3 µg/kg, midazolam 0.2 mg/kg and no premedication respectively. Cardiorespiratory variables were recorded from the time of premedication to awakening from anesthesia. Anxiety and sedation scores and patients acceptance of mask at induction were recorded using four point rating scales. Time of spontaneous eye opening and postoperative emesis occurrence were also recorded. Findings. Children recieving sublingual midazolam or buprenorphine had similar sedation, anxiety and mask acceptance scores, but different from no premedication group (P < 0.0001. None of the children experienced respiratory depression or oxygen desaturation after drug administration and during postoperative period. Time of spontaneous eye opening was longer in the midazolam group (P < 0.0001.Emetic episodes were similar in all groups. Conclusion. Midazolam is extensively studied and demonstrated that the drug is highly effective in alleviating anxiety and increasing cooperation. We concluded that sublingual buprenorphine is as effective as sublingual midazolam in providing sedation and anxitolysis for pediatric premedication.

  4. Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study

    Directory of Open Access Journals (Sweden)

    Cheng-Wen Li

    2015-01-01

    Conclusions: Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.

  5. Possibility of influence of midazolam sedation on the diagnosis of brain death: concentrations of active metabolites after cessation of midazolam.

    Science.gov (United States)

    Hirata, Kiyotaka; Matsumoto, Yoshiaki; Kurokawa, Akira; Onda, Miho; Shimizu, Makiko; Fukuoka, Masamichi; Hirano, Masaaki; Yamamoto, Yasuhiro

    2003-09-01

    Midazolam and its active metabolites have a depressant effect on respiration and consciousness level, and therefore their effects should be considered in all patients for whom brain death testing is contemplated. The concentrations of midazolam and its active metabolites were measured in critically ill patients on a ventilator during and after continuous intravenous infusion of midazolam. Three days after cessation of midazolam infusion, the concentrations of midazolam and 1-hydroxymidazolam decreased to below the therapeutic range (100-1000 ng/ml) in all patients, although the concentrations of 1-hydroxymidazolam glucuronide remained extremely high in a patient who showed deteriorating renal function. The concentrations of 1-hydroxymidazolam glucuronide (19,497-29,761 ng/ml) were measured in this patient. When it is impossible to confirm factors consistent with irreversible brain death, such as the lack of cerebral blood flow, until 3 days after cessation of midazolam infusion, monitoring of the concentration of these substances should be carried out in all patients in whom suspicion exists prior to the evaluation of brain death. It is particularly imperative that monitoring of the 1-hydroxymidazolam glucuronide concentration be carried out in patients with poor renal function.

  6. Anticonvulsant Effectiveness and Hemodynamic Safety of Midazolam in Full-Term Infants Treated with Hypothermia

    NARCIS (Netherlands)

    van den Broek, MPH; Van Straaten, Henrica L M; Huitema, Alwin D R; Egberts, Toine; Toet, MC; De Vries, Linda S.; Rademaker, Karin; Groenendaal, Floris

    2015-01-01

    Background: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. Objectives: The objective was to evaluate the anticonvulsant effectiveness and h

  7. Anticonvulsant effectiveness and hemodynamic safety of midazolam in full-term infants treated with hypothermia

    NARCIS (Netherlands)

    Van Den Broek, Marcel P H; Van Straaten, Henrica L M; Huitema, Alwin D R; Egberts, Toine|info:eu-repo/dai/nl/162850050; Toet, Mona C.; De Vries, Linda S.; Rademaker, Karin; Groenendaal, Floris

    2015-01-01

    Background: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. Objectives: The objective was to evaluate the anticonvulsant effectiveness and h

  8. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety

    NARCIS (Netherlands)

    Barends, Clemens R. M.; Absalom, Anthony; van Minnen, Baucke; Vissink, Arjan; Visser, Anita

    2017-01-01

    Objectives To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. Materials and Methods We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation

  9. Anticonvulsant Effectiveness and Hemodynamic Safety of Midazolam in Full-Term Infants Treated with Hypothermia

    NARCIS (Netherlands)

    van den Broek, MPH; Van Straaten, Henrica L M; Huitema, Alwin D R; Egberts, Toine; Toet, MC; De Vries, Linda S.; Rademaker, Karin; Groenendaal, Floris

    2015-01-01

    Background: Midazolam is used as an anticonvulsant in neonatology, including newborns with perinatal asphyxia treated with hypothermia. Hypothermia may affect the safety and effectiveness of midazolam in these patients. Objectives: The objective was to evaluate the anticonvulsant effectiveness and

  10. The burn wound inflammatory response is influenced by midazolam.

    Science.gov (United States)

    Babcock, George F; Hernandez, Laura; Yadav, Ekta; Schwemberger, Sandy; Dugan, Amy

    2012-02-01

    Burn patients requiring hospitalization are often treated for anxiety with benzodiazepines (BDZs). Benzodiazepines are reported to influence immune system function. Immune system alterations are a major cause of burn-induced mortality. We wanted to determine whether the BDZ, midazolam given daily at an anxiolytic dose, had any influence on the burn injury-induced inflammatory response in the blood and wound. Mice received a 15% total body surface area flame burn and received either midazolam 1 mg/kg i.p. or saline 0.1 ml daily. Blood and skin wounds were harvested 24 h after injection on post-burn day 2, 3, 7, or 8. Mice treated with midazolam had significantly lower serum IL-1β (p=0.002), TNF-α (p=0.002), IL-6 (p=0.016), IL-10 (p=0.009), and TGF-β (p=0.004) than saline-treated mice, with little impact on serum chemokine levels. In the wound, TNF-α and IL-10 were the only cytokines significantly influenced by the drug, being lower (p=0.018) and higher (p=0.006), respectively. The chemokines in the wound influenced significantly by midazolam were MIP-1α, MIP-1β, and MIP-2 while MCP-1 and KC were not. There were more inflammatory cells at the burn wound margin in midazolam-treated mice on post-burn day 3. Although serum nitrate/nitrite was significantly increased by midazolam (p=0.03), both eNOS and iNOS mRNA expression in the wound were similar to the saline group. We found that midazolam given daily after burn injury significantly influenced the inflammatory response. The clinical implications of these findings on wound healing and shock following burn injury, especially larger burns, deserve further investigation.

  11. Translocator protein mediates the anxiolytic and antidepressant effects of midazolam.

    Science.gov (United States)

    Qiu, Zhi-Kun; Li, Ming-Sheng; He, Jia-Li; Liu, Xu; Zhang, Guan-Hua; Lai, Sha; Ma, Jian-Chun; Zeng, Jia; Li, Yan; Wu, Hong-Wei; Chen, Yong; Shen, Yong-Gang; Chen, Ji-Sheng

    2015-12-01

    The translocator protein (18 kDa) (TSPO) plays an important role in stress-related disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD), caused by neurosteroids (e.g. allopregnanolone). The present study sought to evaluate the significance of TSPO in anxiolytic and antidepressant effects induced by midazolam. The animals were administrated midazolam (0.25, 0.5 and 1 mg/kg, i.p.) and subjected to behavioral tests, including Vogel-type conflict test, elevated plus-maze test, forced swimming test. Midazolam produced anxiolytic- and antidepressant-like effects Vogel-type conflict test (1 mg/kg, i.p.), elevated plus-maze test (0.5 and 1 mg/kg, i.p.), and forced swimming test (0.5 and 1 mg/kg, i.p.). These effects of Midazolam were totally blocked by the TSPO antagonist PK11195 (3 mg/kg, i.p.). To evaluate the role of allopregnanolone in the anxiolytic- and antidepressant-like effects of midazolam, the animals were decapitated at the end of the behavioral tests. The allopregnanolone levels of the prefrontal cortex and hippocampus were measured by enzyme-linked immunosorbent assay (ELISA). The allopregnanolone level of the prefrontal cortex and hippocampus was increased by midazolam (0.5, 1 mg/kg, i.p.) and the increase was reversed by PK11195 (3 mg/kg, i.p.). Overall, the results indicated that the anxiolytic- and antidepressant-like effects of midazolam were mediated by TSPO, via stimulation of allopregnanolone biosynthesis.

  12. Evaluation of Pharmacokinetic Interaction between PA-824 and Midazolam in Healthy Adult Subjects

    Science.gov (United States)

    Winter, Helen; Egizi, Erica; Erondu, Ngozi; Ginsberg, Ann; Rouse, Doris J.; Severynse-Stevens, Diana; Pauli, Elliott

    2013-01-01

    This study assessed the safety, tolerability, and pharmacokinetic interaction between PA-824, a novel antitubercular nitroimidazo-oxazine, and midazolam, a CYP3A4 substrate, in 14 healthy adult male and female subjects. The study followed up on observations in vitro that PA-824 caused weak and time-dependent inhibition of CYP3A4. Subjects received a single oral dose of midazolam (2 mg), followed by a 2-day washout. After the washout, all subjects received PA-824 (400 mg) once daily for 14 consecutive days. On day 14, all subjects received the final PA-824 dose coadministered with a 2-mg oral dose of midazolam. The pharmacokinetic endpoints AUC0–t, AUC0–∞, and Cmax for midazolam and 1-hydroxy midazolam were compared between midazolam administered alone versus midazolam coadministered with PA-824. Statistical analysis demonstrated that the mean midazolam values of Cmax, AUC0–t, and AUC0–∞ parameters were reduced by ca. 16, 15, and 15%, respectively, when PA-824 was coadministered with midazolam. The total exposure (AUC) of 1-hydroxy midazolam was 13 to 14% greater when coadministered with PA-824 compared to midazolam administered alone. The Cmax of 1-hydroxy midazolam was similar between treatments. Based on these results, PA-824 does not inhibit or induce CYP3A4 to a clinically meaningful extent and is not likely to markedly affect the pharmacokinetics of CYP3A4 metabolized drugs. PMID:23689718

  13. Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children

    Directory of Open Access Journals (Sweden)

    Al-Zahrani A

    2009-03-01

    Full Text Available Aim: To compare the effectiveness of 0.6 mg/kg oral midazolam sedation alone and a combination of 0.6 mg/kg oral midazolam plus nitrous oxide-oxygen inhalation sedation, in controlling the behavior of uncooperative children during dental treatment. Study Design: The study had a crossover design where the same patient received two different sedation regimens, that is, oral midazolam 0.6 mg/kg and oral midazolam 0.6 mg/kg with nitrous oxide-oxygen inhalation during two dental treatment visits. Materials and Methods: Thirty children (17 males and 13 females were randomly selected for the study, with a mean age of 55.07 (± 9.29 months, ranging from 48 - 72 months. A scoring system suggested by Houpt et al. (1985 was utilized for assessment of the children′s behavior. Results : There was no significant (p > 0.05 difference in the overall behavior assessment between the two sedation regimens, that is, oral midazolam alone and oral midazolam plus nitrous oxide-oxygen. However, the combination of midazolam and nitrous oxide-oxygen showed significantly (p < 0.05 superior results as compared to midazolam alone, in terms of controlling movement and crying during local anesthesia administration and restorative procedures. Conclusion: Compared to oral midazolam alone, a combination of oral midazolam and nitrous oxide inhalation sedation appears to provide more comfort to pediatric dental patients and operators during critical stages of dental treatment.

  14. SODIUM THIOPANTAL AND MIDAZOLAM USE IN NEUROLEPTIC ANESTHESIA

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    P SAJEDI

    2001-12-01

    Full Text Available Introduction: In this study amnesic and anesthetic effects of Midazolam used to reduce awarness and recall of neurolept Anesthesia. Methods: The study was clinical trial with simple random sampling. Patients were studied in four groups of 30 numbers. Each preparation and induction of anesthesia was identical in all groups. Bolous Thiopental (BT group received 0.3mg/kg NaThiopental during induction of Anesthesia. Infusion thiopental group (IT 0.3mg/kg Na thiopental was given during induction plus 100mg/kg/min for Maintaince of anesthesia. Bolous Midazolam (BM group recieved 0.1 mg/kg Midazolam during induction and Infusion Midazolam (lM groug 0.1 mg/kg during Induction plus 0.1mg/kg/h for maintainance of Anesthesia. All groups were observed for signs of awareness and recall. Also hemodynamic variables and duration of recovery were measured and compared between groups with analysis of variance and Chi square tests. Result: Signs of Awareness (tachycardia and Lacrimation in IM group was significantly less than other groups. (P<0.05 Percent of patients reported recall were significantly lower in IM group. (P<0.05 Discussion: Infusion of Midazolam can reduce signs of awareness and recall during neurolept anesthesia without increase in complications or duration of recovery period

  15. Perfeccionamiento del proceso de servicio posventa

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    Nivian Montes de Oca Martínez

    Full Text Available Introducción : la producción de medicamentos requiere de una exigente política de calidad que tenga la finalidad de salvaguardar los intereses del paciente, la sociedad y el Estado. Uno de los procesos más variable dentro del ciclo de vida de un producto y con requisitos muy específicos para el caso de los medicamentos es el servicio posventa. Objetivo: perfeccionar el proceso de servicio posventa de los productos para uso humano que comercializa el Centro Nacional de Sanidad Agropecuaria. Métodos: el estudio se sustenta en la aplicación de herramientas de calidad, como son: diagrama causa-efecto, tormenta de ideas, lista de chequeo, representación de los problemas detectados y aplicación de la metodología planificar-hacer-verificar-actuar. Resultados : se logró identificar a los subprocesos de atención al cliente, competencia, distribución, garantía, adiestramiento para el uso, quejas y reclamaciones, retiro de productos y farmacovigilancia como los factores principales que caracterizan al proceso. Se definieron y evaluaron los requisitos de cada uno de ellos; se obtuvo solo el 54,5 % de su cumplimiento. El diseño e implementación de un plan de mejora, permitió el perfeccionamiento del proceso, con un cumplimiento del 100 % de los requisitos diseñados. Destacan el rediseño de las funciones, responsabilidades, interrelaciones, entradas, salidas, recursos, sistema de procedimientos y registros, con énfasis en subprocesos tan específicos y complejos como la distribución, retiro de productos y la farmacovigilancia. Conclusiones: se aportan indicadores para evaluar el desempeño y facilitar la toma de decisiones y administración más eficiente del proceso, que elevan el nivel de satisfacción de los clientes. Estos resultados contribuyen a mejorar el servicio posventa de los productos con interés comercial y al cumplimiento de los requisitos de las buenas prácticas de fabricación de medicamentos.

  16. Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam.

    Science.gov (United States)

    Eren, Gulay; Dogan, Yuksel; Demir, Guray; Tulubas, Evrim; Hergunsel, Oya; Tekdos, Yasemin; Dogan, Murat; Bilgi, Deniz; Abut, Yesim

    2015-01-01

    Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

  17. Rectal premedication in pediatric anesthesia: midazolam versus ketamine

    Directory of Open Access Journals (Sweden)

    Moshirian N

    2008-06-01

    Full Text Available Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale. Results: Neither medication showed acceptable sedation (>75%, with no significant difference in sedation score between the two groups (P=0.725. Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively. Ease of parental separation was seen in both groups without significant difference (P=0.288 and no major adverse effects, such as apnea, occurred in either group.Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.

  18. Diazepam or midazolam for orotracheal intubation in the ICU?

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    Lísia Gehrke

    2015-02-01

    Full Text Available Objective: to compare clinical and cost effectiveness of midazolam and diazepam for urgent intubation. Methods: patients admitted to the Central ICU of the Santa Casa Hospital Complex in Porto Alegre, over the age of 18 years, undergoing urgent intubation during 6 months were eligible. Patients were randomized in a single-blinded manner to either intravenous diazepam or midazolam. Diazepam was given as a 5 mg intravenous bolus followed by aliquots of 5 mg each minute. Midazolam was given as an intravenous bolus of 5 mg with further aliquots of 2.5 mg each minute. Ramsay sedation scale 5-6 was considered adequate sedation. We recorded time and required doses to reach adequate sedation and duration of sedation. Results: thirty four patients were randomized, but one patient in the diazepam group was excluded because data were lost. Both groups were similar in terms of illness severity and demographics. Time for adequate sedation was shorter (132 ± 87 sec vs. 224 ± 117 sec, p = 0.016 but duration of sedation was similar (86 ± 67 min vs. 88 ± 50 min, p = 0.936 for diazepam in comparison to midazolam. Total drug dose to reach adequate sedation after either drugs was similar (10.0 [10.0-12.5] mg vs. 15.0 [10.0-17.5] mg, p = 0.248. Arterial pressure and sedation intensity reduced similarly overtime with both drugs. Cost of sedation was lower for diazepam than for midazolam (1.4[1.4-1.8] vs. 13.9[9.4-16.2] reais, p <0.001. Conclusions: intubation using intravenous diazepam and midazolam is effective and well tolerated. Sedation with diazepam is associated to a quicker sedation time and to lower costs.

  19. Dexmedetomidine in combination with midazolam after pediatric cardiac surgery.

    Science.gov (United States)

    Hasegawa, Tomomi; Oshima, Yoshihiro; Maruo, Ayako; Matsuhisa, Hironori; Tanaka, Akiko; Noda, Rei; Matsushima, Shunsuke

    2015-09-01

    Although midazolam is one of the most commonly used sedatives for infants in the intensive care unit, it has well-known disadvantages including a dose-dependent potential to induce tolerance, withdrawal, and hemodynamic depression. The aim of this study was to evaluate the clinical effects of dexmedetomidine combined with midazolam in postoperative intensive care following pediatric cardiac surgery. Forty consecutive infants who underwent cardiac surgery for isolated ventricular septal defects from January 2011 to July 2013 were enrolled in this retrospective study. They were divided into two groups according to postoperative sedation regimen: dexmedetomidine sedation with midazolam (n = 20), or midazolam sedation without dexmedetomidine (control group, n = 20). Perioperative variables were compared between the two groups. There were no significant differences in patient characteristics between the two groups. During the first 24 h after intensive care unit admission, heart rate and serum lactate levels were significantly lower in the dexmedetomidine group compared to the control group (p = 0.0292 and p = 0.0027, respectively). The maximal midazolam dose was also significantly lower in the dexmedetomidine group (0.12 ± 0.09 vs. 0.20 ± 0.08 mg kg(-1) h(-1), p = 0.0059). There were no adverse effects of dexmedetomidine such as bradycardia, hypotension, agitation, or seizures. Three (15%) patients in the control group and none in the dexmedetomidine group experienced sudden cardiopulmonary decompensation. Dexmedetomidine can provide favorable sedative properties with a reduced requirement for concomitant midazolam and stable hemodynamics with tachycardia prevention, for postoperative intensive care following pediatric cardiac surgery. © The Author(s) 2015.

  20. Response to intravenous midazolam sedation in general dental practice.

    Science.gov (United States)

    Ellis, S

    1996-06-08

    The object of this study was to grade the response of patients undergoing a variety of dental procedures with the aid of intravenous midazolam sedation in general dental practice and to explore any relationships between the patients preoperative anxiety assessment and the clinician's assessment of co-operation whilst under sedation. One hundred consecutive patients aged between 18 and 58 years (mean 32 years; sd 10 years) and in ASA Class I or II were prospectively studied. Results showed that despite attempts to grade patient's behaviour it was not possible to reliably predict patient's responses under intravenous sedation. In addition to these findings, the great individual variation in sensitivity to midazolam was confirmed.

  1. [Alfentanyl and midazolam in combined anesthesia. Clinical evaluation].

    Science.gov (United States)

    Arena, L; Di Sebastiano, N; Russo, L; Di Filippo, A

    1992-06-01

    We have evaluated the effectiveness of a technique of blended anaesthesia (epidural-general) in 31 patients undergoing major surgery. Thoracic epidural blockade with lidocaina CO2, adrenalin 1/200000, ensures analgesia while induction and hypnosis maintenance were obtained with midazolam, alfentanil, atracurium and N2O/O2. This technique seems able to protect the patients from endotracheal intubation and surgical stress and also to enable a rapid, quiet awakening. The dose of midazolam necessary to maintain hypnosis was inversely proportional to the patient's age. The reversal of hypnosis was necessary in 4 patients only.

  2. Quantitative Analyses of Antagonism: Combinations of Midazolam and Either Flunitrazepam or Pregnanolone in Rhesus Monkeys Discriminating Midazolam

    Science.gov (United States)

    France, Charles P.

    2012-01-01

    Adverse effects of benzodiazepines limit their clinical use; these effects might be reduced without altering therapeutic effects by administering other positive GABAA modulators (i.e., neuroactive steroids) with benzodiazepines. One concern with this strategy involves reversing these combined effects in case of overdose. The current study examined whether flumazenil can attenuate the combined effects of two benzodiazepines, midazolam and flunitrazepam, and the combined effects of midazolam and the neuroactive steroid pregnanolone, in four monkeys discriminating midazolam. Each positive modulator produced ≥80% midazolam-lever responding. Interactions between midazolam and either flunitrazepam or pregnanolone were additive. Flumazenil antagonized the benzodiazepines when they were administered alone or in combination. Schild analyses yielded slopes that did not deviate from unity, regardless of whether benzodiazepines were administered alone or together; the pA2 value for flumazenil was 7.58. In contrast, flumazenil enhanced the effects of pregnanolone with 0.32 mg/kg flumazenil shifting the pregnanolone dose-effect curve 2-fold leftward. Flumazenil attenuated the combined effects of midazolam and pregnanolone, although antagonism was not dose-dependent. Thus, the interaction between two benzodiazepines was similar to that of a benzodiazepine and a neuroactive steroid; however, flumazenil more efficiently attenuated a combination of two benzodiazepines compared with a combination of a benzodiazepine and a neuroactive steroid. Although the magnitude of antagonism of a benzodiazepine combined with a neuroactive steroid was reduced, these results support continued exploration of the use of combinations of positive modulators to enhance therapeutic effects while reducing adverse effects. PMID:22173893

  3. Ketamine and midazolam anesthesia in Pacific martens (Martes caurina).

    Science.gov (United States)

    Mortenson, Jack A; Moriarty, Katie M

    2015-01-01

    Abstract The use of midazolam as a tranquilizer for anesthesia in mustelids in conjunction with the cyclohexamine ketamine is not well documented. Because midazolam is fast acting, inexpensive, and quickly metabolized, it may serve as a good alternative to other more commonly used tranquilizers. We trapped and anesthetized 27 Pacific martens (Martes caurina) in Lassen National Forest (northern California, US) August 2010-April 2013. We assessed anesthesia with ketamine at 18 and 25 mg/kg combined with 0.2 mg/kg of midazolam by comparing mean times of induction, return to consciousness, and recovery, plus physiologic parameters. No reversal was used for the midazolam portion of the anesthetic. Mean (±SD) induction for both ketamine dosages was 1.7±0.5 and 1.8±1.0 min, respectively. Return to consciousness mean times were 8.0 min longer (Pmidazolam provided reliable field anesthesia for Pacific martens, and supplemental oxygen is recommended as needed.

  4. Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam

    Science.gov (United States)

    Kilic, Neslihan; Sahin, Sukran; Aksu, Hale; Yavascaoglu, Belgin; Gurbet, Alp; Turker, Gurkan; Kadioglu, Asli Guler

    2011-01-01

    Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. Materials and Methods: Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3–4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2–0.7 mcg/kg/hr, titrated to achieve an RSS of 3–4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9–10. Patient heart rates, arterial pressure and pain were evaluated. Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion: The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam. PMID:25610153

  5. Intranasal midazolam vs rectal diazepam in acute childhood seizures.

    Science.gov (United States)

    Bhattacharyya, Madhumita; Kalra, Veena; Gulati, Sheffali

    2006-05-01

    One hundred eighty-eight seizure episodes in 46 children were randomly assigned to receive treatment with rectal diazepam and intranasal midazolam with doses of 0.3 mg/kg body weight and 0.2 mg/kg body weight, respectively. Efficacy of the drugs was assessed by drug administration time and seizure cessation time. Heart rate, blood pressure, respiratory rate, and oxygen saturation were measured before and after 5, 10, and 30 minutes following administration of the drugs in both groups. Mean time from arrival of doctor to drug administration was 68.3 +/- 55.12 seconds in the diazepam group and 50.6 +/- 14.1 seconds in the midazolam group (P = 0.002). Mean time from drug administration to cessation of seizure was significantly less in the midazolam group than the diazepam group (P = 0.005). Mean heart rate and blood pressure did not vary significantly between the two drug groups. However, mean respiratory rate and oxygen saturation differed significantly between the two drug groups at 5, 10, and 30 minutes after drug administration. Intranasal midazolam is preferable to rectal diazepam in the treatment of acute seizures in children. Its administration is easy, it has rapid onset of action, has no significant effect on respiration and oxygen saturation, and is socially acceptable.

  6. Reacciones adversas a medicamentos notificadas por pacientes del policlínico Gustavo Aldereguía

    Directory of Open Access Journals (Sweden)

    Adbel Abad Hechavarría Espinosa

    2014-12-01

    Full Text Available Las reacciones adversas a medicamentos son el resultado de una interacción entre el medicamento administrado y algunas características inherentes o adquiridas del paciente y que determinan el patrón individual de respuesta. Se realizó un estudio, donde se describen los principales resultados obtenidos en el sistema de la farmacovigilancia del policlínico “Dr. Gustavo Aldereguía Lima”, en el período comprendido entre enero y diciembre de 2012. Los casos se reportaron a través del modelo 33-36-1, para el reporte de sospecha de reacciones adversas a medicamentos. La muestra estuvo constituida por 242 pacientes notificados con reacciones adversas a medicamentos (RAM, obteniéndose como resultados más relevantes que el 67,3 % eran pacientes del sexo femenino; los meses de abril y mayo fueron los de mayor cantidad de reportes; el 90,9 % fueron reportados por médicos; los grupos farmacológicos que mayor incidencia tuvieron, en el orden siguiente, fueron los antibacterianos, los antihipertensivos y las vacunas; las reacciones más frecuentes fueron el eritema, la fiebre y el prurito, siendo la piel el órgano más reportado; el 30,1 % fueron importantes (según criterios para determinar RAM importantes, descritos en las normas y procedimientos de trabajo del sistema cubano de farmacovigilancia. Según la causalidad, el 95,4 % fueron probables y el 63,2 % frecuentes. El 19,0 % requirió atención de urgencia

  7. Efficacy of Continuous High Dose Midazolam Infusion in Childhood Refractory Generalized Convulsive Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Afshin Fayyazi

    2011-06-01

    Full Text Available bjeciveProlonged and uncontrolled refractory status epilepticus (SE is a life-threatening medical emergency in children (1,2,3. There is no consensus on the optimal therapy for refractory status epilepticus (1. The aim of this study was to develop a new method for treating patients with refractory status epilepticus.Materials & MethodsTen children with refractory status epilepticus in Mofid Hospital, who did not respond to 10 μg/kg per min of intravenous midazolam, had their dose of midazolam increased to 30 μg/kg per min. All children were monitored for the development of side effects.ResultsTen children with no response to low-dose midazolam were given a higher dose of midazolam, and 5 (50% children had a good response. These patients had significantly different response to high-dose midazolam.One patient in the high-dose midazolam group was intubated and required mechanical ventilation. The duration of stay in the hospital and PICU and on mechanical ventilation in patients with no response to low-dose midazolam following with other drugs was longer than in the high-dose midazolam group.No death occurred in high dose midazolam group.ConclusionHigh-midazolam dose drip infusion is a safe and effective protocol for refractory status epilepticus in children.

  8. Mild Hypothermia Alters Midazolam Pharmacokinetics in Normal Healthy Volunteers

    Science.gov (United States)

    Hostler, David; Zhou, Jiangquan; Tortorici, Michael A.; Bies, Robert R.; Rittenberger, Jon C.; Empey, Philip E.; Kochanek, Patrick M.; Callaway, Clifton W.

    2010-01-01

    The clinical use of therapeutic hypothermia has been rapidly expanding due to evidence of neuroprotection. However, the effect of hypothermia on specific pathways of drug elimination in humans is relatively unknown. To gain insight into the potential effects of hypothermia on drug metabolism and disposition, we evaluated the pharmacokinetics of midazolam as a probe for CYP3A4/5 activity during mild hypothermia in human volunteers. A second objective of this work was to determine whether benzodiazepines and magnesium administered intravenously would facilitate the induction of hypothermia. Subjects were enrolled in a randomized crossover study, which included two mild hypothermia groups (4°C saline infusions and 4°C saline + magnesium) and two normothermia groups (37°C saline infusions and 37°C saline + magnesium). The lowest temperatures achieved in the 4°C saline + magnesium and 4°C saline infusions were 35.4 ± 0.4 and 35.8 ± 0.3°C, respectively. A significant decrease in the formation clearance of the major metabolite 1′-hydroxymidazolam was observed during the 4°C saline + magnesium compared with that in the 37°C saline group (p midazolam. This model predicted that midazolam clearance decreases 11.1% for each degree Celsius reduction in core temperature from 36.5°C. Midazolam with magnesium facilitated the induction of hypothermia, but shivering was minimally suppressed. These data provided proof of concept that even mild and short-duration changes in body temperature significantly affect midazolam metabolism. Future studies in patients who receive lower levels and a longer duration of hypothermia are warranted. PMID:20164112

  9. Effects of midazolam on cerebral blood flow in human volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Forster, A.; Juge, O.; Morel, D.

    1982-06-01

    The effects of intravenously administered midazolam on cerebral blood flow were evaluated in eight healthy volunteers using the /sup 133/Xe inhalation technique. Six minutes after an intravenous dose of 0.15 mg/kg midazolam, the cerebral blood flow decreased significantly (P less than 0.001) from a value of 40.6 +/- 3.3 to a value of 27.0 +/- 5.0 ml . 100 g-1 . min-1. Cerebrovascular resistance (CVR) increased from 2.8 +/- 0.2 to 3.9 to 0.6 mmHg/(ml . 100 g-1 . min-1)(P less than 0.001). Mean arterial blood pressure decreased significantly (P less than 0.05) from 117 +/- 8 to 109 +/- 9 mmHg and arterial carbon dioxide tension increased from 33.9 +/- 2.3 to 38.6 +/- 3.2 mmHg (P less than 0.05). Arterial oxygen tension remained stable throughout the study, 484 +/- 95 mmHg before the administration of midazolam and 453 +/- 76 mmHg after. All the subjects slept after the injection of the drug and had anterograde amnesia of 24.5 +/- 5 min. The decrease in mean arterial blood pressure was probably not important since it remained in the physiologic range for cerebral blood flow autoregulation. The increase in arterial carbon dioxide tension observed after the midazolam injection may have partially counteracted the effect of this new benzodiazepine on cerebral blood flow. Our data suggest that midazolam might be a safe agent to use for the induction of anethesia in neurosurgical patients with intracranial hypertension.

  10. Xylazine-midazolam-ketamine versus medetomidine-midazolam-ketamine anesthesia in captive Siberian tigers (Panthera tigris altaica).

    Science.gov (United States)

    Curro, Thomas G; Okeson, Danelle; Zimmerman, Dawn; Armstrong, Douglas L; Simmons, Lee G

    2004-09-01

    Two alpha2-adrenoceptor agents, xylazine and medetomidine, in combination with midazolam and ketamine safely and effectively immobilized Siberian tigers (Panthera tigris altaica). The medetomidine protocol used smaller drug volumes, and induction and recovery times were shorter. Although cardiopulmonary abnormalities were noted, none were likely to be life threatening.

  11. A COMPARATIVE EVALUATION OF A COMBINATION OF MIDAZOLAM AND KETAMINE VERSUS MIDAZOLAM OR KETAMINE ALONE AS ORAL PREMEDICATION FOR CHILDREN

    Directory of Open Access Journals (Sweden)

    Anjali P.

    2015-09-01

    Full Text Available This prospective double blind randomized study was conducted to compare the efficacy of combination of oral ketamine and midazolam with oral midazolam or ketamine alone in terms of acceptability, anxiolysis, sedation and side effects. AIMS AND OBJECTIVE: Compare the efficacy of oral midazolam, oral ketamine and combination of these two drugs, as pre medication in terms of acceptability, sedation, anxiolysis and side effects in paediatric children and t o evaluate whether the addition of oral midazolam to oral ketamine reduces the side effects of oral Ketamine. METHODS: In this randomized prospective study, 90 children of (age 1 - 8 years either sex, ASA grade I and II were randomly allocated to three groups of thirty each. Group M received midazolam 0.75mg/kg, Group K received ketamine 6 mg/kg and Group M+K received midazolam 0.5 mg/kg and ketamine 3 mg/kg via oral route. Formulations of the drugs were given to the children to swallow after mixing with apple juice. The children were separated from their parents 45 minutes after administration of the drug and were taken inside the operation theatre. Acceptability of the drug, time of onset of sedation, level of sedation and anxiolysis at the time of separation from parents and sedation at the time of induction of anaesthesia was noted. Any side effect after administration of the drug and in post - operative period was looked for. RESULTS: The Group K had better acceptance as compared to Group M and Group M+K . The onset of sedation was faster in Group M+K as compared to Group K and Group M, but not statistically significant . The sedation as well as anxiolysis in all the three groups was found to be acceptable at the time of separation; however it was not found to be satisfactory at the time of induction. Incidence of side effects was more in Group K as compared to the other two groups. CONCLUSION: The combination of oral midazolam and oral ketamine in low dose is better premedication than the

  12. MIDAZOLAM SEDATION IN PAEDIATRICS: COMPARATIVE STUDY OF INTRANASAL VERSUS SUBLINGUAL MIDAZOLAM ATOMIZER SPRAY IN PAEDIATRIC PATIENTS UNDERGOING MAGNETIC RESONANCE IMAGING

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    Santhisree

    2014-05-01

    Full Text Available INTRODUCTION: Magnetic Resonance Imaging (MRI causes a great amount of anxiety to both parents and child. Fear of unpleasant procedures and separation from parents may result in lasting and untoward psychological consequences in children. So sedation and anxiolysis is required for children undergoing even for minor diagnostic procedures. OBJECTIVES: The objectives of our study was to compare safety, onset of sedation, degree of sedation produced by intranasal and sublingual administration of midazolam for premedication in children of 4-10 years undergoing MRI. MATERIALS AND METHODS: In this prospective randomized double blind study, the intranasal and sublingual administration of midazolam in pediatric patients who were to undergo MRI was evaluated in 60 children who were aged between 4-10 years with ASA physical status I and II by using a newer midazolam spray. The patients were divided into two groups of 30 patients each and they received Midazolam 0.3 mg/kg. Either intranasally or sublingually in a randomized manner. The heart rate, oxygen saturation (SPO2, respiratory rate and the degree of sedation before and at 3 minutes intervals, recovery score, MRI image quality were recorded and compared. RESULTS: The respiratory rate, heart rate and the oxygen saturation was found from the baseline in both the groups (p >0.05. A sedation score of >3 (approx. was achieved in both the groups within 10 minutes of drug administration. The recovery score did not differ significantly between the two groups (p >0.05. CONCLUSION: Both the intranasal and sublingual administration of Midazolam as sedative is safe and equally effective in pediatric patients.

  13. Direct spinal effect of intrathecal and extradural midazolam on visceral noxious stimulation in rabbits

    DEFF Research Database (Denmark)

    Crawford, M E; Jensen, F M; Toftdahl, D B;

    1993-01-01

    and 30 min. Pain thresholds were unaltered after saline. Extradural midazolam 12.5-250 micrograms kg-1 produced a dose-dependent increase in the percent maximum possible effect ranging from 7% after the smallest dose to 80%. Similar dose-dependent effects were observed after intrathecal injection...... of midazolam 25-62.5 micrograms kg-1. Extradural and intrathecal, but not i.v. injection of flumazenil 25 micrograms kg-1 (a benzodiazepine receptor antagonist) reduced the antinociceptive effect of extradural and intrathecal midazolam to pretreatment levels. A segmental effect of intrathecal midazolam...... was demonstrated using transcutaneous electrical stimulation in the areas of the neck and the lower back. The effect of intrathecal midazolam 62.5 microrgrams kg-1 was restricted to the lumbar region, demonstrating a selective action on the spinal cord. Thus extradural and intrathecal midazolam produced a dose-dependent...

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

    Science.gov (United States)

    Crawford, Daniel

    2016-12-01

    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.

  15. Comparison Of Oral Premedication With Combination Of Midazolam With Ketamine Vs Midazolam Ketamine Alone In Children Children Medical Center (year 2000

    Directory of Open Access Journals (Sweden)

    Hasani M

    2002-09-01

    Full Text Available Anxiolysis and sedation with oral midazolam are common practice in pediatric anesthesia. Good or excellent results are seen in only 50% to 80% of cases, so we decided to investigate if addition of a low dose of oral ketamine to midazolam (ketamine2.5 mg /kg ^midazolam 0.25 mg/kg resulted in better premedication compared with oral midazolam 0.5 mg/kg or ketamine 6 mg/kg alone."nMethods and Materials: in a prospective, randomized ,double -blind study we study 105 children (mean age 6 ,range 2-10 yr. undergoing non thoracic and non cardiac surgery of more than 30 min duration. The patients were in ASA 1, 2. After oral premedication the child's condition was evaluated by assigning 1-4 point to the quality of anxiolysis, sedation, and separation from parents in the induction room .The groups were similar in sex, age, weight, intervention and duration of anaesthesia."nResults: The score of sedation before transfer to the operation room was significantly better in the ketamine, midazolam combination group than in the ketamine or midazolam group. Success rates for anxiolysis and behavior at separation were grater than 90%with the combination, approximately 80% with midazolam and 70% with ketamine alone .The incidence of salivation, excitation, nausea and vomiting was grater in the ketamine group but were very low in other groups. During recovery there were no difference in sedation or time of possible discharge."nConclusion: In summery, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children than with midazolam or ketamine alone. Duration of action and side effects of the combination was similar to those of midazolam.

  16. Antiseizure Activity of Midazolam in Mice Lacking δ-Subunit Extrasynaptic GABA(A) Receptors.

    Science.gov (United States)

    Reddy, Sandesh D; Younus, Iyan; Clossen, Bryan L; Reddy, Doodipala Samba

    2015-06-01

    Midazolam is a benzodiazepine anticonvulsant with rapid onset and short duration of action. Midazolam is the current drug of choice for acute seizures and status epilepticus, including those caused by organophosphate nerve agents. The antiseizure activity of midazolam is thought to result from its allosteric potentiation of synaptic GABA(A) receptors in the brain. However, there are indications that benzodiazepines promote neurosteroid synthesis via the 18-kDa cholesterol transporter protein (TSPO). Therefore, we investigated the role of neurosteroids and their extrasynaptic GABA(A) receptor targets in the antiseizure activity of midazolam. Here, we used δ-subunit knockout (DKO) mice bearing a targeted deletion of the extrasynaptic receptors to investigate the contribution of the extrasynaptic receptors to the antiseizure activity of midazolam using the 6-Hz and hippocampus kindling seizure models. In both models, midazolam produced rapid and dose-dependent protection against seizures (ED50, 0.4 mg/kg). Moreover, the antiseizure potency of midazolam was undiminished in DKO mice compared with control mice. Pretreatment with PK11195 [1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide], a TSPO blocker, or finasteride, a 5α-reductase neurosteroid inhibitor, did not affect the antiseizure effect of midazolam. The antiseizure activity of midazolam was significantly reversed by pretreatment with flumazenil, a benzodiazepine antagonist. Plasma and brain levels of the neurosteroid allopregnanolone were not significantly greater in midazolam-treated animals. These studies therefore provide strong evidence that neurosteroids and extrasynaptic GABA(A) receptors are not involved in the antiseizure activity of midazolam, which mainly occurs through synaptic GABA(A) receptors via direct binding to benzodiazepine sites. This study reaffirms midazolam's use for controlling acute seizures and status epilepticus.

  17. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation

    OpenAIRE

    Lima Alessandra Rodrigues de Almeida; Costa Luciane Ribeiro de Rezende Sucasas da; Costa Paulo Sérgio Sucasas da

    2003-01-01

    The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0...

  18. The Effect of Saquinavir on the Rate of Metabolism of Midazolam

    Science.gov (United States)

    2013-01-31

    Hensyl, 1990). Saquinavir and Midazolam 8 Ki The inhibition constant for Michaelis - Menten kinetics which describes the ability of a drug to inhibit...Redacted] PREFACE This study was conducted to provide information regarding the kinetic interaction between midazolam and saquinavir. Midazolam is a...the catalysis of a second drug (Fabre et. al., 1988). Km The Michaelis constant that describes the affinity of an enzyme to a particular substrate

  19. Midazolam Induces Cellular Apoptosis in Human Cancer Cells and Inhibits Tumor Growth in Xenograft Mice

    Science.gov (United States)

    Mishra, Siddhartha Kumar; Kang, Ju-Hee; Lee, Chang Woo; Oh, Seung Hyun; Ryu, Jun Sun; Bae, Yun Soo; Kim, Hwan Mook

    2013-01-01

    Midazolam is a widely used anesthetic of the benzodiazepine class that has shown cytotoxicity and apoptosis-inducing activity in neuronal cells and lymphocytes. This study aims to evaluate the effect of midazolam on growth of K562 human leukemia cells and HT29 colon cancer cells. The in vivo effect of midazolam was investigated in BALB/c-nu mice bearing K562 and HT29 cells human tumor xenografts. The results show that midazolam decreased the viability of K562 and HT29 cells by inducing apoptosis and S phase cell-cycle arrest in a concentration-dependent manner. Midazolam activated caspase-9, capspase-3 and PARP indicating induction of the mitochondrial intrinsic pathway of apoptosis. Midazolam lowered mitochondrial membrane potential and increased apoptotic DNA fragmentation. Midazolam showed reactive oxygen species (ROS) scavenging activity through inhibition of NADPH oxidase 2 (Nox2) enzyme activity in K562 cells. Midazolam caused inhibition of pERK1/2 signaling which led to inhibition of the anti-apoptotic proteins Bcl-XL and XIAP and phosphorylation activation of the pro-apoptotic protein Bid. Midazolam inhibited growth of HT29 tumors in xenograft mice. Collectively our results demonstrate that midazolam caused growth inhibition of cancer cells via activation of the mitochondrial intrinsic pathway of apoptosis and inhibited HT29 tumor growth in xenograft mice. The mechanism underlying these effects of midazolam might be suppression of ROS production leading to modulation of apoptosis and growth regulatory proteins. These findings present possible clinical implications of midazolam as an anesthetic to relieve pain during in vivo anticancer drug delivery and to enhance anticancer efficacy through its ROS-scavenging and pro-apoptotic properties. PMID:24008365

  20. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial

    OpenAIRE

    Katayoun Salem; Shaqayegh Kamranzadeh; Maryam Kousha; Shahnaz Shaeghi; Fatemeh AbdollahGorgi

    2015-01-01

    Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF))” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and e...

  1. Effect of midazolam on memory: a study of process dissociation procedure and functional magnetic resonance imaging.

    Science.gov (United States)

    Tian, S Y; Zou, L; Quan, X; Zhang, Y; Xue, F S; Ye, T H

    2010-06-01

    To assess the effects of midazolam on explicit and implicit memories, 12 volunteers were randomly divided into the two groups: one with an Observer's Assessment of Alertness/Sedation score of 3 (mild sedation) and one with a score of 1 (deep sedation). Blood oxygen-level-dependent functional magnetic resonance imaging was measured before and during an auditory stimulus, then with midazolam sedation, and then during a second auditory stimulus with continuous midazolam sedation. After 4 h, explicit and implicit memories were assessed. There was no evidence of explicit memory at the two levels of midazolam sedation. Implicit memory was retained at a mild level of midazolam sedation but absent at a deep level of midazolam sedation. At a mild level of midazolam sedation, activation of all brain areas by auditory stimulus (as measured by functional magnetic resonance imaging) was uninhibited. However, a deep level of midazolam sedation depressed activation of the superior temporal gyrus by auditory stimulus. We conclude that midazolam does not abolish implicit memory at a mild sedation level, but can abolish both explicit and implicit memories at a deep sedation level. The superior temporal gyrus may be one of the target areas.

  2. Midazolam in rabbits terminates dysrhythmias caused by intracerebroventricular ropivacaine

    Institute of Scientific and Technical Information of China (English)

    Yao-min ZHU; Zu-yi YUAN; Hui WU; Dan-dan ZHOU; Gui-xia JING

    2011-01-01

    The current study was designed to investigate the mechanisms by which ropivacaine may act within the central nervous system (CNS) to produce cardiotoxicity.Eighty New Zealand rabbits were divided into four groups randomly.In Group 1,20 rabbits received intracerebroventricular (icv) saline,and then received icv ropivacaine 30 min later.In Group 2,20 rabbits received icv ropivacaine.Whenever dysrhythmias continued for more than 5 min,0.1 ml saline was administered into the left cerebral ventricle.Ten minutes later,0.1 ml midazolam was given into the left lateral ventricle.In Group 3,20 rabbits received icv ropivacaine,and once the dysrhythmias developed,the inspired isoflurane concentration was increased from 0.75% to 1.50%.In Group 4,20 animals received an intravenous (iv)phenylephrine infusion until dysrhythmias occurred.In Group 1,the rabbits did not develop dysrhythmias in response to icv saline,whereas dysrhythmias did develop in these animals after icv ropivacaine.In Group 2,icv saline had no effect on the dysrhythmias; however,icv midazolam terminated cardiac dysrhythmias.In Group 3,an increase in the concentration of the inspired isoflurane had no effect on dysrhythmias.In Group 4,icv midazolam had no effect on dysrhythmias in response to iv phenylephrine.Ropivacaine administered directly into the CNS is capable of producing cardiac dysrhythmias; midazolam terminated dysrhythmias presumably by potentiation of γ-aminobutyric acid (GABA)receptor activity.Our results suggest that ropivacaine produces some of its cardiotoxicity not only by the direct cardiotoxicity of the drug,but also by the CNS effects of ropivacaine.

  3. Accidental IV administration of epinephrine instead of midazolam at colonoscopy

    Directory of Open Access Journals (Sweden)

    Ahmed Gado

    2016-03-01

    Full Text Available Drug administration errors appear to be a major source of iatrogenic harm to hospitalized patients. They often, particularly in the case of epinephrine, have catastrophic consequences both for the patient and the well-meaning provider. The following incident is a medication error case report which illustrates one way that incorrect medication may be administered. IV epinephrine was accidentally administered instead of midazolam at colonoscopy.

  4. Disruption of cortical integration during midazolam-induced light sedation.

    Science.gov (United States)

    Liang, Peipeng; Zhang, Han; Xu, Yachao; Jia, Wenbin; Zang, Yufeng; Li, Kuncheng

    2015-11-01

    This work examines the effect of midazolam-induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double-blind, placebo-controlled, cross-over, within-subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting-state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower-level functional networks and higher-order functions related ones. Independent component analysis (ICA) was used to identify these resting-state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam-induced light sedation while the higher-order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower-level networks was maintained, while that of the higher-level networks was significantly disrupted by light sedation. The within-network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher-order cognitive functions including memory, attention, executive function, and language were impaired prior to lower-level sensory responses during sedation. Our result also lends support to the information integration model of consciousness.

  5. Reversal of midazolam sedation with flumazenil following conservative dentistry.

    Science.gov (United States)

    Davies, C A; Sealey, C M; Lawson, J I; Grant, I S

    1990-04-01

    The purpose of this double-blind randomized study was to assess recovery of mental function following reversal of midazolam-induced sedation with the specific antagonist flumazenil (R015-1788) or placebo following conservative dental procedures. Recovery was assessed using choice reaction time and critical flicker fusion threshold, both objective tests of psychomotor function; linear analogue sedation scores and simple memory tests. Assessments were repeated up to 3 h after administration of flumazenil or placebo to discover whether recovery was sustained or whether resedation occurred due to the short duration of action of flumazenil. Flumazenil in doses from 0.5 to 1.0 mg rapidly reversed the sedative and amnesic effects of a mean dose of 8.2 mg of midazolam without apparent evidence of subsequent resedation. Since recovery of mental function in the control group had ordinarily occurred 45 min after administration of placebo, routine reversal of midazolam sedation with flumazenil cannot be justified. Nevertheless, in cases of undue sedation persisting after dental treatment, flumazenil may be used with minimal risk of resedation occurring.

  6. Inter-individual variation in midazolam clearance in children

    Science.gov (United States)

    Altamimi, Mohammed I; Sammons, Helen; Choonara, Imti

    2015-01-01

    Objectives To determine the extent of inter-individual variation in clearance of midazolam in children and establish which factors are responsible for this variation. Methods A systematic literature review was performed to identify papers describing the clearance of midazolam in children. The following databases were searched: Medline, Embase, International Pharmaceutical Abstracts, CINAHL and Cochrane Library. From the papers, the range in plasma clearance and the coefficient of variation (CV) in plasma clearance were determined. Results 25 articles were identified. Only 13 studies gave the full range of clearance values for individual patients. The CV was greater in critically ill patients (18%–170%) than non-critically ill patients (13%–54%). Inter-individual variation was a major problem in all age groups of critically ill patients. The CV was 72%–106% in preterm neonates, 18%–73% in term neonates, 31%–130% in infants, 21%–170% in children and 47%–150% in adolescents. The mean clearance was higher in children (1.1–16.7 mL/min/kg) than in neonates (0.78–2.5 mL/min/kg). Conclusions Large inter-individual variation was seen in midazolam clearance values in critically ill neonates, infants, children and adolescents. PMID:25281734

  7. Antiseizure Activity of Midazolam in Mice Lacking δ-Subunit Extrasynaptic GABAA Receptors

    Science.gov (United States)

    Reddy, Sandesh D.; Younus, Iyan; Clossen, Bryan L.

    2015-01-01

    Midazolam is a benzodiazepine anticonvulsant with rapid onset and short duration of action. Midazolam is the current drug of choice for acute seizures and status epilepticus, including those caused by organophosphate nerve agents. The antiseizure activity of midazolam is thought to result from its allosteric potentiation of synaptic GABAA receptors in the brain. However, there are indications that benzodiazepines promote neurosteroid synthesis via the 18-kDa cholesterol transporter protein (TSPO). Therefore, we investigated the role of neurosteroids and their extrasynaptic GABAA receptor targets in the antiseizure activity of midazolam. Here, we used δ-subunit knockout (DKO) mice bearing a targeted deletion of the extrasynaptic receptors to investigate the contribution of the extrasynaptic receptors to the antiseizure activity of midazolam using the 6-Hz and hippocampus kindling seizure models. In both models, midazolam produced rapid and dose-dependent protection against seizures (ED50, 0.4 mg/kg). Moreover, the antiseizure potency of midazolam was undiminished in DKO mice compared with control mice. Pretreatment with PK11195 [1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide], a TSPO blocker, or finasteride, a 5α-reductase neurosteroid inhibitor, did not affect the antiseizure effect of midazolam. The antiseizure activity of midazolam was significantly reversed by pretreatment with flumazenil, a benzodiazepine antagonist. Plasma and brain levels of the neurosteroid allopregnanolone were not significantly greater in midazolam-treated animals. These studies therefore provide strong evidence that neurosteroids and extrasynaptic GABAA receptors are not involved in the antiseizure activity of midazolam, which mainly occurs through synaptic GABAA receptors via direct binding to benzodiazepine sites. This study reaffirms midazolam’s use for controlling acute seizures and status epilepticus. PMID:25784648

  8. Oral Midazolam-Ketamine versus Midazolam alone for Procedural Sedation of Children Undergoing Computed Tomography; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Saeed Majidinejad

    2015-05-01

    Full Text Available Introduction: Motion artifacts are a common problem in pediatric radiographic studies and are a common indication for pediatric procedural sedation. This study aimed to compare the combination of oral midazolam and ketamine (OMK with oral midazolam alone (OM as procedural sedatives among children undergoing computed tomography (CT imaging. Methods: The study population was comprised of six-month to six-year old patients with medium-risk minor head trauma, who were scheduled to undergo brain CT imaging. Patients were randomly allocated to two groups: one group received 0.5 mg/kg midazolam (OM group; n = 33 orally and the other one received 0.2 mg/kg midazolam and 5 mg/kg ketamine orally (OMK group; n=33. The vital signs were monitored and recorded at regular intervals. The primary outcome measure was the success rate of each drug in achieving adequate sedation. Secondary outcome measures were the time to achieve adequate sedation, time to discharge from radiology department, and the incidence of adverse events. Results: Adequate sedation was achieved in five patients (15.2% in OM group and 15 patients (45.5% in OMK group, which showed a statistically significant difference between the groups (P = 0.015. No significant difference was noted between OM and OMK groups with respect to the time of achieving adequate sedation (33.80 ± 7.56 and 32.87 ± 10.18 minutes, respectively; P = 0.854 and the time of discharging from radiology department (89.60 ± 30.22 and 105.27 ± 21.98 minutes, respectively; P=0.223. The complications were minor and similar among patients of both groups. Conclusion: This study demonstrated that in comparison with OM, OMK was more effective in producing a satisfactory level of sedation in children undergoing CT examinations without additional complications; however, none of these two regimens fulfilled clinical needs for procedural sedation.

  9. Midazolam intranasal para la sedación preanestésica pediátrica

    Directory of Open Access Journals (Sweden)

    Joaquín L. de la Lastra Rodríguez

    1995-12-01

    Full Text Available El ingreso hospitalario y un tratamiento quirúrgico pueden crear en los niños temor, ansiedad y trastornos emocionales al abandonar la atmósfera de seguridad y confianza del hogar y estar en el ambiente desconocido del hospital. La medicación preanestésica logra la reducción de la ansiedad y disminuye su respuesta. En el presente trabajo se utilizó con este fin el midazolam al 0,5 % (dormicum en dosis de 0,2 a 0,3 mg por kg de peso corporal administrado por vía intranasal, con la finalidad de observar las ventajas de este método en 30 niños menores de 5 años de edad. Se logró una sedación rápida y de corta duración y no se observó ninguna complicación.

  10. Combination of Midazolam and Butorphanol for Sedation for Tympanoplasty under Monitored Anaesthesia Care

    OpenAIRE

    2016-01-01

    Background: Tympanoplasty is routinely done under local anaesthesia with sedation due to various advantages. Systemic analgesics and sedatives are generally given to improve the patient comfort. Aim & Objectives: To determine the effectiveness of combination of midazolam and butorphanol for sedation and to assess the sedation technique using midazolam and butorphanol for tympanoplasty under monitored anaesthesia care. Material and Methods: One hundred patients sched...

  11. Inhibition of cardiac Kv1.5 potassium current by the anesthetic midazolam: mode of action

    Directory of Open Access Journals (Sweden)

    Vonderlin N

    2014-11-01

    Full Text Available Nadine Vonderlin,1 Fathima Fischer,1 Edgar Zitron,1,2 Claudia Seyler,1 Daniel Scherer,1 Dierk Thomas,1,2 Hugo A Katus,1,2 Eberhard P Scholz1 1Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany; 2German Centre for Cardiovascular Research (DZHK, Partner Site Heidelberg/Mannheim, Heidelberg, GermanyAbstract: Midazolam is a short-acting benzodiazepine that is widely used in anesthesia. Despite its widespread clinical use, detailed information about cardiac side effects of midazolam is largely lacking. Using the double-electrode voltage clamp technique, we studied pharmacological effects of midazolam on heterologously expressed Kv1.5 channels underlying atrial repolarizing current IKur. Midazolam dose-dependently inhibited Kv1.5 current, yielding an IC50 of 17 µM in an HEK cell line and an IC50 of 104 µM in Xenopus oocytes. We further showed that midazolam did not affect the half-maximal activation voltage of Kv1.5 channels. However, a small negative shift of the inactivation curve could be observed. Midazolam acted as a typical open-channel inhibitor with rapid onset of block and without frequency dependence of block. Taken together, midazolam is an open channel inhibitor of cardiac Kv1.5 channels. These data add to the current understanding of the pharmacological profile of midazolam.Keywords: anesthetics, potassium channels, pharmacology

  12. Effects of midazolam and morphine on cerebral oxygenation and hemodynamics in ventilated premature infants.

    NARCIS (Netherlands)

    Velden, A.A.E.M. van der; Hopman, J.C.W.; Klaessens, J.H.G.M.; Feuth, A.B.; Sengers, R.C.A.; Liem, K.D.

    2006-01-01

    BACKGROUND: Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. OBJECTIVES: To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. METHODS: 11 patients (GA 26.6-33.0 weeks, BW 78

  13. An investigation of the effect of midazolam on the pain experience.

    Science.gov (United States)

    Coulthard, P; Rood, J P

    1992-08-01

    In a randomised, double-blind, cross-over study on 20 healthy human volunteers, the effect of intravenous midazolam on pain tolerance using the 'submaximum effort tourniquet technique' is described. Intravenous midazolam administered in conscious sedation doses was found to significantly reduce the affective and motivational component of the pain experience.

  14. Effects of ketamine and midazolam on morphine induced dependence and tolerance in mice

    Directory of Open Access Journals (Sweden)

    Bohlul Habibi Asl Kambiz Hassanzadeh

    2004-08-01

    Full Text Available The aim of this study was to investigate the effects of ketamine and midazolam on prevention of the development of morphine tolerance and dependence in mice. Different groups of mice received morphine (50 mg/kg, sc, morphine (50 mg/kg, sc + ketamine (25,50,75 mg/kg, ip, morphine (50 mg/kg, sc + midazolam (0.5,1,2 mg/kg, ip , morphine (50 mg/kg , sc + ketamine (50 mg/kg, ip + midazolam (1 mg/kg, ip once a day for four days. Tolerance was assessed by administration of morphine (9 mg/kg, ip on fifth day. Withdrawal symptoms were assessed by administration of naloxane (4 mg/kg, ip two hours after co-administration of morphine with either ketamine or midazolam. It was found that pretreatment with ketamine or midazolam decreased the degree of tolerance and withdrawal symptoms. Additionally co-administration of ketamine and midazolam before morphine therapy decreased the tolerance and dependence significantly. From these results it may concluded that administration of ketamine and midazolam alone or in combination could prevent the development of tolerance and dependence to morphine. These effects can be related to the N-Methyl-D-Aspartate (NMDA receptor antagonist behavior of ketamine and GABA-receptor agonist behavior of midazolam.

  15. Inhibition of cardiac Kv1.5 potassium current by the anesthetic midazolam: mode of action

    Science.gov (United States)

    Vonderlin, Nadine; Fischer, Fathima; Zitron, Edgar; Seyler, Claudia; Scherer, Daniel; Thomas, Dierk; Katus, Hugo A; Scholz, Eberhard P

    2014-01-01

    Midazolam is a short-acting benzodiazepine that is widely used in anesthesia. Despite its widespread clinical use, detailed information about cardiac side effects of midazolam is largely lacking. Using the double-electrode voltage clamp technique, we studied pharmacological effects of midazolam on heterologously expressed Kv1.5 channels underlying atrial repolarizing current IKur. Midazolam dose-dependently inhibited Kv1.5 current, yielding an IC50 of 17 μM in an HEK cell line and an IC50 of 104 μM in Xenopus oocytes. We further showed that midazolam did not affect the half-maximal activation voltage of Kv1.5 channels. However, a small negative shift of the inactivation curve could be observed. Midazolam acted as a typical open-channel inhibitor with rapid onset of block and without frequency dependence of block. Taken together, midazolam is an open channel inhibitor of cardiac Kv1.5 channels. These data add to the current understanding of the pharmacological profile of midazolam. PMID:25422586

  16. Midazolam as an anticonvulsant antidote for organophosphate intoxication--A pharmacotherapeutic appraisal.

    Science.gov (United States)

    Reddy, Sandesh D; Reddy, Doodipala Samba

    2015-06-01

    This review summarizes the therapeutic potential of midazolam as an anticonvulsant antidote for organophosphate (OP) intoxication. Benzodiazepines are widely used to treat acute seizures and status epilepticus (SE), a neurologic emergency of persistent seizures that can lead to severe neuronal damage or death. Midazolam is a benzodiazepine hypnotic with a rapid onset and short duration of action. Midazolam is considered the new drug of choice for persistent acute seizures and SE, including those caused by neurotoxic OPs and nerve agents. Midazolam is a positive allosteric modulator of synaptic γ-aminobutyric acid (GABA)A receptors in the brain. It potentiates GABAergic inhibition and thereby controls hyperexcitability and seizures. Midazolam is administered intravenously or intramuscularly to control acute seizures and SE. Due to its favorable pharmacokinetic features, midazolam is being considered as a replacement anticonvulsant for diazepam in the antidote kit for nerve agents. Clinical studies such as the recent Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) trial have confirmed the anticonvulsant efficacy of midazolam in SE in prehospital settings. In experimental models, midazolam is effective when given at the onset of seizures caused by nerve agents. However, benzodiazepines are less effective at terminating seizures when given 30 min or later after OP exposure or seizure onset, likely because of internalization or downregulation of synaptic, but not extrasynaptic, GABAA receptors, which can lead to diminished potency and seizure recurrence. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  17. Midazolam as an anticonvulsant antidote for organophosphate intoxication− A pharmacotherapeutic appraisal

    Science.gov (United States)

    Reddy, Sandesh D.; Reddy, Doodipala Samba

    2015-01-01

    SUMMARY Objective This review summarizes the therapeutic potential of midazolam as an anticonvulsant antidote for organophosphate (OP) intoxication. Methods Benzodiazepines are widely used for acute seizures and status epilepticus (SE), a neurological emergency of persistent seizures that can lead to severe neuronal damage or death. Midazolam is a benzodiazepine hypnotic with a rapid onset and short duration of action. Results Midazolam is considered the new drug of choice for persistent acute seizures and SE, including those caused by neurotoxic OPs and nerve agents. Midazolam is a positive allosteric modulator of synaptic GABA-A receptors in the brain. It potentiates GABAergic inhibition and thereby controls hyperexcitability and seizures. Midazolam is administered intravenously or intramuscularly to control acute seizures and SE. Due to its favorable pharmacokinetic features, midazolam is being considered as a replacement anticonvulsant for diazepam in the antidote kit for nerve agents. Clinical studies such as the recent RAMPART trial have confirmed the anticonvulsant efficacy of midazolam in SE in prehospital settings. Significance In experimental models, midazolam is effective when given at the onset of seizures caused by nerve agents. However, benzodiazepines are less effective at terminating seizures when given 30 min or later after OP exposure or seizure onset likely because of internalization or down-regulation of synaptic, but not extrasynaptic, GABA-A receptors, which can lead to diminished potency and seizure recurrence. PMID:26032507

  18. Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study

    Science.gov (United States)

    Li, Cheng-Wen; Li, Yan-Dong; Tian, Hai-Tao; Kong, Xian-Gang; Chen, Kui

    2015-01-01

    Background: Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation. Methods: Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified “spray-as-you-go” technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg−1·h−1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg−1·h−1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers’ Assessment of Alertness/Sedation of 2–3. The quality of intubation conditions and adverse events were observed. Results: The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2 after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen. PMID:26612286

  19. Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study

    Institute of Scientific and Technical Information of China (English)

    Cheng-Wen Li; Yan-Dong Li; Hai-Tao Tian; Xian-Gang Kong; Kui Chen

    2015-01-01

    Background: Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway.The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation.Methods: Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n =25 per group) by a computer-generated randomization schedule.All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified "spray-as-you-go" technique.Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg-1 ·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μtg·kg-1·h-L As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers'Assessment of Alertness/Sedation of 2-3.The quality of intubation conditions and adverse events were observed.Results: The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z =0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05).Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2 after intubation cwas higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs.42.2 ± 4.3 mmHg, t =2.495, P < 0.05).Conclusions: Both dexmedetomidine and sufentanil are effective as an adjuvant forAFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.

  20. Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study.

    Science.gov (United States)

    Li, Cheng-Wen; Li, Yan-Dong; Tian, Hai-Tao; Kong, Xian-Gang; Chen, Kui

    2015-12-05

    Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation. Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified "spray-as-you-go" technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg-1·h-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers' Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed. The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.

  1. INTRATHECAL MIDAZOLAM PROLONGS THE ANALGESIC EFFECTS OF SPINAL BLOCKADE WITH LIDOCAINE FOR PERINEAL OPERATION

    Directory of Open Access Journals (Sweden)

    B. Jahangiri R. Jahangiri

    2006-09-01

    Full Text Available Intrathecal administration of midazolam has been reported to have antinociceptive action, and to be an effective analgesic agent. In this prospective double-blind study we aimed to evaluate the postoperative effects of intrathecal midazolam with lidocaine following perineal operation. Forty patients were randomly allocated to two groups: 20 patients in the control group received 2 ml of 5% heavy lidocaine plus 0.4 ml of 0.9% saline intrathecally; 20 patients in the midazolam group received 2 ml of 5% heavy lidocaine plus 0.4 ml of 0.5% midazolam. Duration of analgesia was significantly greater in the midazolam group (7  1 hours compared to the control group (1.5  0.5 hours.

  2. Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia.

    Science.gov (United States)

    Jo, Youn Yi; Lee, Dongchul; Jung, Wol Seon; Cho, Noo Ree; Kwak, Hyun Jeong

    2016-10-04

    BACKGROUND Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. MATERIAL AND METHODS One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. RESULTS Hypotension occurred more frequently in the midazolam group (Pmidazolam sedation.

  3. Comparison of blood microsampling with DBS and conventional blood collection techniques used in a midazolam biostudy.

    Science.gov (United States)

    Lachance, Sylvain; Théberge, Marie-Claude; Havard, Guy; Anctil, Dominique; Barrière, Olivier; Croteau, Sara; Pellerin, Brigitte; Lévesque, Ann

    2016-04-01

    Quantitative DBS LC-MS/MS assay for midazolam was used to compare two sample collection techniques (venipuncture and finger prick) and the midazolam concentrations measured in plasma samples, DBS and dried plasma spots. Midazolam was extracted from DBS cards and compared with whole blood collected from usual venipuncture. Dried plasma spots were also compared with plasma. The blood volume used as well as the temperature impact during the blood and plasma deposits was evaluated. Midazolam was administrated to six healthy subjects during a clinical trial to obtained blood and plasma samples for the statistical comparison. The method for midazolam using DBS was validated and showed an excellent performance. Excellent correlations were observed when the same collection procedures were used.

  4. Characterization of midazolam metabolism in locusts: The role of CYP3A4-like enzyme in the formation of 1'-OH and 4-OH midazolam

    DEFF Research Database (Denmark)

    Olsen, Line Rørbæk; Gabel-Jensen, Charlotte; Wubshet, Sileshi Gizachew

    2016-01-01

    1. The metabolism of midazolam was investigated in vivo in locusts in order to evaluate the presence of an enzyme with functionality similar to human CYP3A4/5. 2. Hydroxylated metabolites of midazolam identical to human metabolites were detected in locusts and the apparent affinities (Km values...... one in each case) of the imidazole ring. 5. Distribution of midazolam and the glucose conjugates were successfully measured using desorption electrospray mass spectrometry imaging revealing time-dependent changes in distribution over time. 6. In conclusion, it appears that an enzyme with functionality...... similar to human CYP3A4/5 is present in locusts. However, it appears that conjugation with glucose is the main detoxification pathway of midazolam in locusts....

  5. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures.

    Science.gov (United States)

    Thakker, Arpita; Shanbag, Preeti

    2013-02-01

    The objective of this study is to compare the safety and efficacy of midazolam given intranasally with diazepam given intravenously in the treatment of acute childhood seizures. A randomized controlled study was conducted in a pediatric emergency department in a tertiary general hospital. Fifty children aged from 1 month to 12 years presenting with acute seizures of at least 10 min duration were enrolled during a 12 month period. Intranasal midazolam (0.2 mg/kg) and intravenous diazepam (0.3 mg/kg) were administered. The main outcome measures were interval between arrival at hospital and starting treatment and interval between arrival at hospital and cessation of seizures. Intranasal midazolam and intravenous diazepam were equally effective. Overall 18 of 27 seizures were controlled with midazolam and 15 of 23 with diazepam. The mean interval between arrival at hospital and starting treatment was significantly shorter in the midazolam group [3.37 min (SD 2.46)] as compared to the diazepam group [14.13 min (SD 3.39)]. The mean interval between cessation of seizures and arrival at hospital was significantly shorter in the midazolam group [6.67 min (SD 3.12)] as compared to the diazepam group [17.18 min (SD 5.09)]. The mean interval between control of seizures and administration of the drug was shorter in the diazepam group [2.67 min (SD 2.31)] as compared to the midazolam group [3.01 min (SD 2.79)]. No significant side effects were observed in either group. Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam. Midazolam was as safe and effective as diazepam. The overall interval between arrival at hospital and cessation of seizures was shorter with intranasal midazolam than with intravenous diazepam. The intranasal route can be possibly used not only in medical centres, but with appropriate instruction by the parents of children with acute seizures at home.

  6. Midazolam impairs the retrieval of conditioned taste aversion via opioidergic transmission in mice.

    Science.gov (United States)

    Yasoshima, Yasunobu; Shimura, Tsuyoshi

    2017-01-01

    Midazolam is a benzodiazepine agonist that affects the acquisition, retention, and retrieval of malaise-induced conditioned taste aversion (CTA) in rats. Our previous study suggested that the palatability-enhancing rather than amnesic effects of midazolam were responsible for impaired retrieval of conditioned aversion to palatable conditioned stimuli (CSs). However, it remains unclear whether this effect is opioid-dependent. In the present study, we examined the involvement of opioid signaling with the ability of peripheral midazolam administration to transiently impair CTA retrieval in mice. CTA was established by pairing 5mM saccharin ingestion (conditioned stimulus, CS) with an intraperitoneal (i.p.) injection of 0.15M lithium chloride (LiCl, 2% body weight) (unconditioned stimulus) for two consecutive days. Conditioned mice that received midazolam (1.5mg/kg, i.p.) before the first retention test consumed significantly more saccharin (CS) than conditioned mice that received vehicle (phosphate-buffered physiological saline, PBS; i.p.). On the next day, both conditioned groups showed strong aversions to the CS. Next, naloxone, an opioid receptor antagonist, was peripherally administered prior to the midazolam injection before the retention test. Pre-administration of naloxone but not PBS attenuated midazolam-induced increases in CS intake. Finally, we examined aversive orofacial taste reactions (TRs) to an oral infusion of the CS with pre-administration of naloxone or PBS prior to midazolam using a taste reactivity test. Conditioned mice that received midazolam showed significantly longer latencies to express aversive orofacial TRs than those that received PBS. Pre-administration of naloxone eliminated the effect of midazolam on latency to express aversive TRs. Taken together, these data suggest that midazolam activates opioidergic transmission and opioid-dependent palatability enhancement of the CS to eliminate conditioned aversion to a sweet taste. Copyright

  7. Parenteral midazolam is superior to diazepam for treatment of prehospital seizures.

    Science.gov (United States)

    Clemency, Brian M; Ott, Jamie A; Tanski, Christopher T; Bart, Joseph A; Lindstrom, Heather A

    2015-01-01

    Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures. A retrospective chart review of a single, large, commercial agency during a 29-month period was performed. The period included alternating shortages of both medications. Ambulances were stocked with either diazepam or midazolam based on availability of the drugs. Adult patients who received at least 1 parenteral dose of diazepam or midazolam for treatment of seizures were included. The regional prehospital protocol recommended 5 mg intravenous (IV) diazepam, 5 mg intramuscular (IM) diazepam, 5 mg IM midazolam, or 2.5 mg IV midazolam. Medication effectiveness was compared with respect to the primary end point: cessation of seizure without repeat seizure during the prehospital encounter. A total of 440 study subjects received 577 administrations of diazepam or midazolam and met the study criteria. The subjects were 52% male, with a mean age of 48 (range 18-94) years. A total of 237 subjects received 329 doses of diazepam, 64 (27%) were treated with first-dose IM. A total of 203 subjects received 248 doses of midazolam; 71 (35%) were treated with first-dose IM. Seizure stopped and did not recur in 49% of subjects after parenteral diazepam and 65% of subjects after parenteral midazolam (p = 0.002). Diazepam and midazolam exhibited similar first dose success for IV administration (58 vs. 62%; p = 0.294). Age, gender, seizure history, hypoglycemia, the presence of trauma, time to first administration, prehospital contact time, and frequency of IM administration were similar between groups. For parenteral administration, midazolam demonstrated superior first-dose seizure suppression. This study demonstrates how periods of drug scarcity can be utilized to study prehospital medication effectiveness.

  8. Effects of oral clotrimazole troches on the pharmacokinetics of oral and intravenous midazolam

    Science.gov (United States)

    Shord, Stacy S; Chan, Lingtak-Neander; Camp, Joseph R; Vasquez, Eva M; Jeong, Hyun-Young; Molokie, Robert E; Baum, Charles L; Xie, Hui

    2010-01-01

    AIMS The aim of the study was to determine the effects of oral clotrimazole troches on the pharmacokinetics of oral and intravenous midazolam in the plasma. METHODS We conducted a randomized, open-label, four-way crossover study in 10 healthy volunteers. Each volunteer received oral midazolam 2 mg or intravenous midazolam 0.025 mg kg−1 with and without oral clotrimazole troches 10 mg taken three times daily for 5 days. Each study period was separated by 14 days. Serial blood samples were collected up to 24 h after oral midazolam and 6 h after intravenous midazolam. Plasma concentrations for midazolam and its metabolite 1-hydroxymidazolam were measured and fitted to a noncompartmental model to estimate the pharmacokinetic parameters. RESULTS Ten healthy volunteers aged 21–26 years provided written informed consent and were enrolled into the study. Clotrimazole decreased the apparent oral clearance of midazolam from 57 ± 13 l h−1[95% confidence interval 48, 66] to 36 ± 9.8 l h−1 (95% confidence interval 29, 43) (P= 0.003). These changes were accompanied by a decrease in the area under the concentration–time curve (mean difference 22 µg h−1 l−1, P= 0.001) and bioavailability (mean difference 0.21, P= NS). There were no significant differences in the systemic clearance of midazolam with or without clotrimazole troches. CONCLUSIONS Oral clotrimazole troches decreased the apparent oral clearance of midazolam; no significant differences in the systemic clearance of midazolam were found. PMID:20233179

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

    Science.gov (United States)

    Boku, Aiji; Sugimura, Mitsutaka; Oyamaguchi, Aiko; Inoue, Mika; Niwa, Hitoshi

    2016-01-01

    Background The 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 Methods This 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. Results Midazolam 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. Conclusions The 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. PMID:27031068

  10. Flumazenil reversal of midazolam sedation in the elderly.

    Science.gov (United States)

    Katz, J A; Fragen, R J; Dunn, K L

    1991-01-01

    In a randomized, double-blind, placebo-controlled study, the efficacy of flumazenil in reversing the psychomotor, sedative, and amnestic effects of midazolam in elderly patients after surgery under regional anesthesia was examined. Thirty ASA I-III patients older than 63 years undergoing regional anesthesia with midazolam sedation were randomly assigned to receive either intravenous flumazenil (n = 19) or intravenous placebo (n = 11) after surgery. After assessments of sedation immediately postoperatively, 0.1 mg/ml flumazenil or placebo was given in 2-ml increments twice, a minute apart, and titrated in further 2-ml increments until patients were awake or until 10 ml had been given. Efficacy of reversal was determined using patient and observer assessments of sedation and simple psychomotor tests administered preoperatively and at five, 15, 30, 60, 120, and 180 minutes after test drug administration. Reversal of amnesia was tested by assessing recall of pictures shown at five, 15, 30, and 60 minutes after drug administration. Time profiles of digit substitution test and observer assessment of sedation data were significantly different between the flumazenil and placebo groups. For observer's assessment of sleep, significant differences were noted between flumazenil and placebo groups only at five, 15, and 30 minutes after test drug administration. A significant difference was noted between flumazenil and placebo patients in the ability to recall pictures shown five and 15 minutes after drug administration, but not pictures shown at 30 or 60 minutes. Within-group analysis demonstrated that loss of difference over time between flumazenil and placebo groups was the result of decreasing effect of both flumazenil and midazolam.

  11. Midazolam challenge reinduces neurological deficits after transient ischemic attack.

    Science.gov (United States)

    Lazar, Ronald M; Fitzsimmons, Brian-Fred; Marshall, Randolph S; Mohr, J P; Berman, Mitchell F

    2003-03-01

    A transient ischemic attack (TIA) in the brain is classically considered a syndrome lasting <24 hours. Having previously shown that an experimental challenge with the GABAA agonist midazolam in recovered stroke patients can reinduce the acute clinical state, we determined whether TIA patients would demonstrate a similar effect. Four right-handed patients participated: 3 with clinical TIA presumed to have affected the left hemisphere within the previous 24 to 72 hours and no evidence of a new lesion on diffusion-weighted and fluid-attenuated inversion recovery imaging, and 1 patient with an asymptomatic temporal arteriovenous malformation. The TIA duration ranged from 30 minutes to 3 hours. Each patient underwent baseline testing for motor function and aphasia, after which intravenous midazolam was delivered until mild drowsiness was detected. Patients were tested during the peak drug effect and again after 2 hours when sedation had dissipated. No patient showed weakness or aphasia at baseline. After administration of midazolam, all 3 TIA patients demonstrated re-emergence of features that characterized their recent transient neurological syndromes (right-sided weakness and/or aphasia) but no left-sided findings. The arteriovenous malformation patient who had never been symptomatic showed no drug effect. Two hours later, all TIA patients returned to their normal clinical state. Patients who had suffered recent transient cerebral ischemic episodes and were neurologically intact with negative diffusion-weighted imaging showed re-emergence of prior focal deficits after administration of a benzodiazepine in a dose that produces light sedation. These findings suggest that presumed TIA may produce neuronal dysfunction beyond the symptomatic period.

  12. Midazolam sedation for the reduction of Colles' fractures.

    Science.gov (United States)

    Grant, A; Hoddinott, C; Evans, R

    1993-08-01

    The treatment of Colles' fractures in the elderly comprises a heavy workload for both accident and orthopaedic departments. The initial management has important clinical and financial implications for patient and hospital. The demand is variable and the ability to respond must also be flexible. The choice of anaesthetic technique is therefore most important. In our experience, intravenous sedation with midazolam (a water soluble benzodiazepine) has proven to be safe and effective in providing good conditions for anatomical reduction of Colles' fractures on an outpatient basis.

  13. Flumazenil reversal of midazolam sedation for dental procedures.

    Science.gov (United States)

    el-Attar, A; Adu-Gyamfi, Y; Tawfique, K

    1992-06-01

    The efficacy of flumazenil in the reversal of midazolam sedation was assessed in double-blind placebo controlled study. Thirty patients undergoing oral surgical procedures were included. Flumazenil administration was followed by immediate rise of the CNS functions scores to almost the baseline awake values. Compared to control group, patients were significantly more oriented and had better comprehension up to 15 minutes, more alert for 30 minutes and had better memory function up to 60 minutes. Peripheral oxygen saturation was significantly higher up to 15 minutes. Flumazenil allows better utilization and higher turn over rate where space and nursing resources are scarce.

  14. Comparison of anticonvulsant tolerance, crosstolerance, and benzodiazepine receptor binding following chronic treatment with diazepam or midazolam.

    Science.gov (United States)

    Ramsey-Williams, V A; Wu, Y; Rosenberg, H C

    1994-07-01

    In a previous study, rats treated chronically with flurazepam were tolerant to the anticonvulsant action of some benzodiazepines (BZs), but not others (34). To determine if this differential crosstolerance was unique to flurazepam, rats were treated chronically with diazepam or midazolam, and tested for tolerance to the anticonvulsant actions of diazepam, midazolam, clonazepam, and clobazam. Regional benzodiazepine receptor binding in brain was also studied. In contrast to previous findings with flurazepam, 1 week treatment with diazepam or with midazolam did not cause tolerance. Rats treated with diazepam for 3 weeks were tolerant to diazepam, clonazepam, clobazam, and midazolam. In contrast, rats treated 3 weeks with midazolam were tolerant to diazepam and midazolam, but not clobazam or clonazepam. Neither diazepam nor midazolam treatment for 3 weeks altered BZ binding in cerebral cortex, cerebellum, or hippocampus. The effects of chronic BZ treatment depended not only on the BZ given chronically, but also on the BZ used to evaluate these effects, suggesting drug-specific interactions of different BZs with their receptors.

  15. The anxiolytic effect of midazolam in third molar extraction: a systematic review.

    Directory of Open Access Journals (Sweden)

    Qi Chen

    Full Text Available To assess the efficacy of midazolam for anxiety control in third molar extraction surgery.Electronic 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.Ten 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.It 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.

  16. Comparative Study of Intranasal Midazolam and Intravenous Benzodiazepines in Control of Seizures in Children

    Directory of Open Access Journals (Sweden)

    Janki Panchal

    2013-02-01

    Full Text Available Background: Seizures are very common in pediatric patients. As duration of seizures impacts morbidity and mortality to child’s life, control of seizures should be achieved as early as possible, preferably at home. Rectal diazepam and intranasal midazolam are available methods for control of seizures and can be learnt by parents. Methods: We assessed safety and efficacy of intranasal midazolam for control of seizures and also compared its effect with other benzodiazepines given by intravenous route. Results: Among 84 patients, success rate of treatment with Midazolam (intranasal was 45.5% and success rate with Benzodiazepines (intravenous was 90%. The difference is statistically significant. In present study, average time recorded to give drug after arrival at hospital in IN Midazolam group was 0.379 min, where as it was 1.598 min in IV Benzodiazepine group. Average time for cessation of seizures after giving drug was 3.001 min in IN Midazolam group, where as it was 1.009 min in IV Benzodiazepine group. Conclusion: Intra-venous route for control of seizures is most effective compare to Inta-nasal Midazolam. However intranasal Midazolam can be use full when IV access is not available at home or during transport of patient to health care centre. [Natl J of Med Res 2013; 3(1.000: 30-33

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

    Science.gov (United States)

    Chen, Qi; Wang, Lufei; Ge, Lina; Gao, Yuan; Wang, Hang

    2015-01-01

    Purpose To assess the efficacy of midazolam for anxiety control in third molar extraction surgery. Methods Electronic 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. Results Ten 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. Conclusion It 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. PMID:25849859

  18. Midazolam exacerbates morphine tolerance and morphine-induced hyperactive behaviors in young rats with burn injury.

    Science.gov (United States)

    Song, Li; Wang, Shuxing; Zuo, Yunxia; Chen, Lucy; Martyn, Jeevendra A; Mao, Jianren

    2014-05-20

    Midazolam and morphine are often used in pediatric intensive care unit (ICU) for analgesia and sedation. However, how these two drugs interact behaviorally remains unclear. Here, we examined whether (1) co-administration of midazolam with morphine would exacerbate morphine tolerance and morphine-induced hyperactive behaviors, and (2) protein kinase C (PKC) would contribute to these behavioral changes. Male rats of 3-4 weeks old were exposed to a hindpaw burn injury. In Experiment 1, burn-injured young rats received once daily saline or morphine (10mg/kg, subcutaneous, s.c.), followed 30min later by either saline or midazolam (2mg/kg, intraperitoneal, i.p.), for 14 days beginning 3 days after burn injury. In Experiment 2, young rats with burn injury were administered with morphine (10mg/kg, s.c.), midazolam (2mg/kg, i.p.), and chelerythrine chloride (a non-specific PKC inhibitor, 10nmol, intrathecal) for 14 days. For both experiments, cumulative morphine anti-nociceptive dose-response (ED50) was tested and hyperactive behaviors such as jumping and scratching were recorded. Following 2 weeks of each treatment, ED50 dose was significantly increased in rats receiving morphine alone as compared with rats receiving saline or midazolam alone. The ED50 dose was further increased in rats receiving both morphine and midazolam. Co-administration of morphine and midazolam also exacerbated morphine-induced hyperactive behaviors. Expression of the NR1 subunit of the N-methyl-d-aspartate (NMDA) receptor and PKCγ in the spinal cord dorsal horn (immunohistochemistry; Western blot) was upregulated in burn-injured young rats receiving morphine alone or in combination with midazolam, and chelerythrine prevented the development of morphine tolerance. These results indicate that midazolam exacerbated morphine tolerance through a spinal NMDA/PKC-mediated mechanism.

  19. Sarin-induced brain damage in rats is attenuated by delayed administration of midazolam.

    Science.gov (United States)

    Chapman, Shira; Yaakov, Guy; Egoz, Inbal; Rabinovitz, Ishai; Raveh, Lily; Kadar, Tamar; Gilat, Eran; Grauer, Ettie

    2015-07-01

    Sarin poisoned rats display a hyper-cholinergic activity including hypersalivation, tremors, seizures and death. Here we studied the time and dose effects of midazolam treatment following nerve agent exposure. Rats were exposed to sarin (1.2 LD50, 108 μg/kg, im), and treated 1 min later with TMB4 and atropine (TA 7.5 and 5 mg/kg, im, respectively). Midazolam was injected either at 1 min (1 mg/kg, im), or 1 h later (1 or 5 mg/kg i.m.). Cortical seizures were monitored by electrocorticogram (ECoG). At 5 weeks, rats were assessed in a water maze task, and then their brains were extracted for biochemical analysis and histological evaluation. Results revealed a time and dose dependent effects of midazolam treatment. Rats treated with TA only displayed acute signs of sarin intoxication, 29% died within 24h and the ECoG showed seizures for several hours. Animals that received midazolam within 1 min survived with only minor clinical signs but with no biochemical, behavioral, or histological sequel. Animals that lived to receive midazolam at 1h (87%) survived and the effects of the delayed administration were dose dependent. Midazolam 5 mg/kg significantly counteracted the acute signs of intoxication and the impaired behavioral performance, attenuated some of the inflammatory response with no effect on morphological damage. Midazolam 1mg/kg showed only a slight tendency to modulate the cognitive function. In addition, the delayed administration of both midazolam doses significantly attenuated ECoG compared to TA treatment only. These results suggest that following prolonged seizure, high dose midazolam is beneficial in counteracting adverse effects of sarin poisoning.

  20. In-vivo animation of midazolam-induced electrocorticographic changes in humans

    Science.gov (United States)

    Nishida, Masaaki; Sood, Sandeep; Asano, Eishi

    2009-01-01

    Previous human studies have demonstrated that midazolam-induced signal changes on scalp EEG recording include widespread augmentation of sigma-oscillations and that the amplitude of such oscillations is correlated to the severity of midazolam-induced amnesia. Still unanswered questions include whether midazolam-induced sigma-augmentation also involves the medial temporal region, which plays a role in memory encoding. Taking advantage of rare and unique opportunities to monitor neuronal activities using intracranial electrocorticography (ECoG) recording, we determined how intravenous administration of midazolam induced spectral frequency changes in the human cerebral cortex, including the medial temporal region. We studied three children with focal epilepsy who underwent subdural electrode placement and extraoperative ECoG recording for subsequent resection of the seizure focus; an intravenous bolus of midazolam was given to abort an ongoing simple-partial seizure or to provide sedation prior to induction of general anesthesia. ‘Midazolam-induced ECoG frequency alteration’ in sites distant from the seizure focus was sequentially animated on their individual three-dimensional MR images. The common ECoG changes induced by midazolam included gradual augmentation of sigma-oscillations (12-16 Hz) in the widespread non-epileptic regions, including the medial temporal region. The spatial and temporal alteration of ECoG spectral frequency pattern can be appreciated via animation movies. Midazolam-induced sigma-augmentation was observed in the medial temporal region in our relatively small cohort of human subjects. In-vivo animation of ECoG spectral measures provided a unique situation to study the effect of midazolam on neuronal processing in the deep brain regions. PMID:19733366

  1. Midazolam Exacerbates Morphine Tolerance and Morphine-induced Hyperactive Behaviors in Young Rats with Burn Injury

    Science.gov (United States)

    Song, Li; Wang, Shuxing; Zuo, Yunxia; Chen, Lucy; Martyn, Jeevendra A.; Mao, Jianren

    2014-01-01

    Midazolam and morphine are often used in pediatric intensive care unit (ICU) for analgesia and sedation. However, how these two drugs interact behaviorally remains unclear. Here, we examined whether 1) co-administration of midazolam with morphine would exacerbate morphine tolerance and morphine-induced hyperactive behaviors, and 2) protein kinase C (PKC) would contribute to these behavioral changes. Male rats of 3 to 4 weeks old were exposed to a hindpaw burn injury. In Experiment 1, burn-injured young rats received once daily saline or morphine (10 mg/kg, subcutaneous, s.c.), followed 30 min later by either saline or midazolam (2 mg/kg, intraperitoneal, i.p.), for 14 days beginning 3 days after burn injury. In Experiment 2, young rats with burn injury were administered with morphine (10 mg/kg, s.c.), midazolam (2 mg/kg, i.p.), and chelerythrine chloride (a non-specific PKC inhibitor 10 nmol, intrathecal) for 14 days. For both experiments, cumulative morphine anti-nociceptive dose-response (ED50) was tested and hyperactive behaviors such as jumping and scratching were recorded. Following 2 weeks of each treatment, ED50 dose was significantly increased in rats receiving morphine alone as compared with rats receiving saline or midazolam alone. The ED50 dose was further increased in rats receiving both morphine and midazolam. Co-administration of morphine and midazolam also exacerbated morphine-induced hyperactive behaviors. Expression of the NR1 subunit of the N-methyl-D-aspartate (NMDA) receptor and PKCγ in the spinal cord dorsal horn (immunohistochemistry; Western blot) was upregulated in burn-injured young rats receiving morphine alone or in combination with midazolam, and chelerythrine prevented the development of morphine tolerance. These results indicate that midazolam exacerbated morphine tolerance through a spinal NMDA/PKC-mediated mechanism. PMID:24713351

  2. Inhalation of 50% Oxygen Does Not Impair Respiratory Depression During Midazolam Sedation.

    Science.gov (United States)

    Ninomiya, Aya; Matsuura, Nobuyuki; Ichinohe, Tatsuya

    2016-10-01

    To investigate how inhalation of 50% oxygen during intravenous midazolam sedation affects respiratory variables and thus the availability of oxygen. Study subjects were 21 healthy adult volunteers (American Society of Anesthesiologists physical status I). They were allocated to undergo midazolam sedation during high-concentration oxygen inhalation (group H) or during normal air inhalation (group N) in a single-blinded randomized crossover design, with an interval of at least 3 days between the 2 sedation sessions. In each experiment, midazolam 0.05 mg/kg was administered, after which the following variables were measured for 40 minutes: oxygen saturation by pulse oximetry (SpO2), end-tidal carbon dioxide partial pressure (ETCO2), respiration rate (RR), tidal volume (VT), and minute volume (MV). Subsequently, flumazenil 0.5 mg was administered, and the same variables were measured for 10 minutes. SpO2 decreased after midazolam administration in the 2 groups. SpO2 in group H was higher than that in group N at all time points. RR increased and VT decreased after midazolam administration in the 2 groups; however, in contrast to SpO2, the levels of these parameters did not meaningfully differ between groups at any time point. MV remained unchanged in the 2 groups. ETCO2 decreased similarly after midazolam administration in the 2 groups. Inhalation of 50% oxygen during midazolam sedation did not enhance respiratory depression by midazolam. This suggests that high-concentration oxygen inhalation during midazolam sedation could prevent hypoxia. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Oral premedication for pediatric anaesthesia: a comparison between midazolam and clonidine

    Directory of Open Access Journals (Sweden)

    Anupam Das

    2016-06-01

    Results: In the midazolam group 23 (76.67% children had no apprehension after parental separation and at induction (P and #706;0.001, sedation score at induction was significant higher in midazolam group versus clonidine group (93.33% versus 66.6%, P<0.01, clonidine resulted in a more stable pulse and blood pressure peri-operatively (P<0.05. Conclusion: Oral midazolam has better efficacy in terms of preoperative sedation and oral clonidine had stable hemodynamic profile and better analgesia in the clonidine group. [Int J Res Med Sci 2016; 4(6.000: 2341-2347

  4. Is premedication with midazolam more effective by the sublingual than the oral route?

    OpenAIRE

    Gupta, Shobhana; Gadani, Hina; Kedia, Shravan

    2011-01-01

    Background: In this study, we compared the sedative effects of sublingual midazolam solution with the oral tablet as premedication. Sixty pediatric patients of ASA physical status I and II were randomly selected to receive either 0.5 mg/kg of tablet or 0.5 mg/kg of sublingual solution of midazolam as premedication, about 45 min before elective surgery. Materials and Methods: There were 30 patients in each group. In Group I, the patients received premedication in the form of oral midazolam tab...

  5. Effects of ketamine and midazolam on morphine induced dependence and tolerance in mice

    OpenAIRE

    Bohlul Habibi Asl Kambiz Hassanzadeh

    2004-01-01

    The aim of this study was to investigate the effects of ketamine and midazolam on prevention of the development of morphine tolerance and dependence in mice. Different groups of mice received morphine (50 mg/kg, sc), morphine (50 mg/kg, sc) + ketamine (25,50,75 mg/kg, ip), morphine (50 mg/kg, sc) + midazolam (0.5,1,2 mg/kg, ip) , morphine (50 mg/kg , sc) + ketamine (50 mg/kg, ip) + midazolam (1 mg/kg, ip) once a day for four days. Tolerance was assessed by administration of morphine (9 mg/kg,...

  6. Semiphysiologically based pharmacokinetic model for midazolam and CYP3A mediated metabolite 1-OH-midazolam in morbidly obese and weight loss surgery patients.

    Science.gov (United States)

    Brill, M J E; Välitalo, P A J; Darwich, A S; van Ramshorst, B; van Dongen, H P A; Rostami-Hodjegan, A; Danhof, M; Knibbe, C A J

    2016-01-01

    This study aimed to describe the pharmacokinetics of midazolam and its cytochrome P450 3A (CYP3A) mediated metabolite 1-OH-midazolam in morbidly obese patients receiving oral and i.v. midazolam before (n = 20) and one year after weight loss surgery (n = 18), thereby providing insight into the influence of weight loss surgery on CYP3A activity in the gut wall and liver. In a semiphysiologically based pharmacokinetic (semi-PBPK) model in which different blood flow scenarios were evaluated, intrinsic hepatic clearance of midazolam (CLint,H) was 2 (95% CI 1.40-1.64) times higher compared to morbidly obese patients before surgery (P Midazolam gut wall clearance (CLint,G) was slightly lower in patients after surgery (P > 0.05), with low values for both groups. The results of the semi-PBPK model suggest that, in patients after weight loss surgery, CYP3A hepatic metabolizing capacity seems to recover compared to morbidly obese patients, whereas CYP3A mediated CLint,G was low for both populations and showed large interindividual variability.

  7. Wide variation in patient response to midazolam sedation for outpatient oral surgery.

    Science.gov (United States)

    Richards, A; Griffiths, M; Scully, C

    1993-10-01

    Intravenous midazolam in doses of between 0.07 mg/kg and 0.1 mg/kg has been recommended for sedation in dentistry and some medical procedures and investigations. This study examined the variable sensitivity of patients to midazolam. One hundred and thirty-four fit but anxious patients between the ages of 16 and 63 years received midazolam intravenously for sedation for minor oral surgery. Doses required ranged from 0.04 to 0.40 mg/kg. Nineteen patients required doses less than 0.07 mg/kg; 59 patients required doses greater than 0.1 mg/kg. The mean dose per kilogram required for males was significantly less than for females. The wide variation in sensitivity to midazolam is confirmed.

  8. The effect of critical illness and inflammation on midazolam therapy in children

    NARCIS (Netherlands)

    N.J. Vet (Nienke); M. de Hoog (Matthijs); D. Tibboel (Dick); S.N. de Wildt (Saskia)

    2012-01-01

    textabstractOBJECTIVE:: To determine the effect of inflammation and disease severity on midazolam pharmacokinetics (as surrogate marker of cytochrome 3A activity) and pharmacodynamics in critically ill children. DESIGN:: Analysis of prospectively collected pharmacokinetic and pharmacodynamic data

  9. Application to Add Midazolam to the Model List of Essential Medicines

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); N.J. Vet (Nienke); S.N. de Wildt (Saskia)

    2011-01-01

    textabstractSummary statement of the proposal for inclusion The benzodiazepine midazolam has proven sedative, anxiolytic and amnesic properties. It is extensively used for premedication and procedural sedation in both adults and children. In comparison to other benzodiazepine and

  10. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    Directory of Open Access Journals (Sweden)

    Yen-Hsuan Hsu

    2015-06-01

    Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

  11. Involvement of endothelium-dependent and -independent mechanisms in midazolam-induced vasodilation.

    Science.gov (United States)

    Colussi, Gian Luca; Di Fabio, Alessandro; Catena, Cristiana; Chiuch, Alessandra; Sechi, Leonardo A

    2011-08-01

    Benzodiazepine (BDZ) infusion has been shown to reduce blood pressure in both humans and animals. Although the inhibitory effects of BDZ on the central nervous system have been well documented, less is known about the direct effects of BDZ on the vascular bed. The aims of this study were to assess the effects of the BDZ midazolam on the vascular system in C57/BL6 mouse aortic rings and to investigate the mechanisms of its direct vascular action. We found that midazolam induced reversible, dose-dependent vasodilation in potassium- and phenylephrine-precontracted rings. In rings that were precontracted with potassium or phenylephrine, treatment with 10 μmol l(-1) midazolam increased vasodilation by 15 and 60%, respectively, compared with baseline. Vasodilation increased by 80 and 87%, respectively, after treatment with 50 μmol l(-1) midazolam. Only the low concentration of midazolam (10 μmol l(-1)) induced endothelium-dependent vasodilation in phenylephrine-precontracted rings. Vasodilation increased by 60% in rings with endothelium and by 20% in rings without endothelium. Conversely, only the high concentration of midazolam (50 μmol l(-1)) reduced the CaCl(2)-induced vasoconstriction of aortic rings with EC(50) (the concentration giving 50% of the maximal effect) values of 1 and 6 mmol l(-1) for vehicle- and midazolam-treated rings, respectively. Furthermore, the incubation of phenylephrine-precontracted rings with an inhibitor of the nitric oxide synthase (NOS) NG-nitro-L-arginine methyl ester or the inhibitors of central or peripheral type BDZ receptors (flumazenil or PK 11195, respectively) produced no change in midazolam-induced vasodilation. Thus, low concentrations of midazolam induce vasodilation via an endothelium-dependent mechanism that does not involve NO production. In contrast, high concentrations of midazolam induce vasodilation via an endothelium-independent mechanism that implies reduced sensitivity of aortic rings to calcium ions. Additionally

  12. Combination of Midazolam and Butorphanol for Sedation for Tympanoplasty under Monitored Anaesthesia Care

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    Vinay Dhakate

    2016-01-01

    Full Text Available Background: Tympanoplasty is routinely done under local anaesthesia with sedation due to various advantages. Systemic analgesics and sedatives are generally given to improve the patient comfort. Aim & Objectives: To determine the effectiveness of combination of midazolam and butorphanol for sedation and to assess the sedation technique using midazolam and butorphanol for tympanoplasty under monitored anaesthesia care. Material and Methods: One hundred patients scheduled for tympanoplasty under local anaesthesia were given bolus doses of intravenous midazolam 0.03 mg/kg and butorphanol 0.03 mg/kg followed by midazolam infusion at 0.01 mg/kg/hr. If required, additional bolus doses of 0.01 mg/kg of both midazolam and butorphanol were given to achieve desired sedation and analgesia. The total dosage of midazolam and butorphanol, vital parameters, sedation score using Ramsay sedation score, pain score and surgeon satisfaction score using Numeric rating scale were recorded. Results: Ninety nine patients underwent tympanoplasty satisfactorily with sedation technique. Only one patient needed conversion to general anaesthesia. The mean duration of surgery was 92.7±8.16 minutes. The total midazolam and butorphanol dosages were 2.45±0.233 mg and 1.65±0.179 mg respectively. The desired Ramsay Sedation Score (RSS of 3 and pain score Numerical Rating Scale (NRS = 2.82±0.72 were achieved within 4-8 minutes. No side effects of excessive sedation were observed. Conclusion: Combined use of midazolam and butorphanol in low doses produces adequate sedation for tympanoplasty under local anaesthesia without serious adverse effects.

  13. Effect of continuous infusion of midazolam on immune function in pediatric patients after surgery.

    Science.gov (United States)

    Lu, H B; Jia, Y P; Liang, Z H; Zhou, R; Zheng, J Q

    2015-08-21

    The current study was performed to investigate the effects of midazolam on immune function in pediatric patients after surgery and possible mechanism involved. Patients who needed sedation for more than 2 consecutive days after undergoing surgery in the Pediatric Surgery Department of our hospital were enrolled for the study. Fifty-six patients (5-14 years old) were randomly divided into midazolam and propofol treatment groups (N = 28 each in each group). Pediatric patients received midazolam or profolol via continuous intravenous administration, and their plasma cytokine levels were compared after 48 h. Cultured rat C6 brain glioma cells were pretreated with a range of concentrations of midazolam or propofol for 60 minutes prior to incubation with 10 ng/mL IL-1β in serum-free medium or vehicle for 36 h. IL-6 concentration was subsequently measured using ELISA. In comparison with levels measured before the infusion of midazolam for 48 h, concentrations of all cytokines decreased, with the differences in IL-1β, IL-8, and TNF-α concentrations reaching significance (all P Midazolam significantly suppressed the IL-1β-induced release of IL-6 in rat C6 glioma cells. This inhibition was concentration-dependent between 0.3 and 3 μM, with 3 μM concentration of midazolam decreasing the IL-1β-induced release of IL-6 by 43.58%. Midazolam can significantly inhibit the release of cytokines in pediatric patients after surgery. One of the mechanisms may be the inhibition of IL-1β- induced release of IL-6 in the central nervous system.

  14. A pilot study of the efficacy of oral midazolam for sedation in pediatric dental patients.

    OpenAIRE

    Haas, D. A.; Nenniger, S. A.; Yacobi, R.; Magathan, J. G.; Grad, H. A.; Copp, P. E.; Charendoff, M. D.

    1996-01-01

    Oral midazolam is being used for conscious sedation in dentistry with little documentation assessing its efficacy. In order to accumulate preliminary data, a randomized, double-blind, controlled, crossover, multi-site pilot study was conducted. The objective was to determine if 0.6 mg/kg of oral midazolam was an equally effective or superior means of achieving conscious sedation in the uncooperative pediatric dental patient, compared with a commonly used agent, 50 mg/kg of oral chloral hydrat...

  15. Intestinal first pass metabolism of midazolam in liver cirrhosis --effect of grapefruit juice

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Pedersen, Natalie; Larsen, Niels-Erik

    2002-01-01

    AIMS: Grapefruit juice inhibits CYP3A4 in the intestinal wall leading to a reduced intestinal first pass metabolism and thereby an increased oral bioavailability of certain drugs. For example, it has been shown that the oral bioavailability of midazolam, a CYP3A4 substrate, increased by 52......, but these changes were not statistically significant, whereas C(max) of the metabolite decreased to 30% (14, 47%) (Ppass metabolism of midazolam. This is likely to occur...

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

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    Diogo Gorayeb de Castro

    2015-12-01

    Full Text Available 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 < 0.001 and MPG (p < 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.

  17. Comparison of Midazolam and Propofol for BIS-Guided Sedation During Regional Anaesthesia

    OpenAIRE

    Priyanka Khurana; Ankit Agarwal; R. K. Verma; Gupta, P K

    2009-01-01

    Summary Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset & recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desi...

  18. Placebo-controlled trial of midazolam sedation in mechanically ventilated newborn babies.

    Science.gov (United States)

    Jacqz-Aigrain, E; Daoud, P; Burtin, P; Desplanques, L; Beaufils, F

    1994-09-03

    Although midazolam is used for sedation of mechanically ventilated newborn babies, this treatment has not been evaluated in a randomised trial. We have done a prospective placebo-controlled study of the effects of midazolam on haemodynamic variables and sedation as judged by a five-item behaviour score. 46 newborn babies on mechanical ventilation for respiratory distress syndrome were randomly assigned to receive midazolam (n = 24) or placebo (n = 22) as a continuous infusion. Doses of midazolam were calculated to obtain plasma concentrations between 200 and 1000 ng/mL within 24 h of starting treatment and to maintain these values throughout the study. Haemodynamic and ventilatory variables were noted every hour, as were complications and possible side-effects of treatment. Mean (SD) duration of inclusion was 78.7 (30.9) h. 1 patient in the treatment group and 7 in the placebo group were withdrawn because of inadequate sedation (p < 0.05). Midazolam gave a significantly better sedative effect than placebo, as estimated by the behaviour score (p < 0.05). Heart rate and blood pressure were reduced by treatment but remained within the normal range for gestational age and there was no effect on ventilatory indices. The incidence of complications was similar in the two groups. No midazolam-related side-effects were noted. Continuous infusion of midazolam at doses adapted to gestational age induces effective sedation in newborn babies on mechanical ventilation, with positive effects on haemodynamic variables. The course of the respiratory distress syndrome was not influenced by this treatment. Midazolam was given over only a few days and the limited effects on heart rate and blood pressure that we report should not encourage long-term administration.

  19. Pharmacokinetics and pharmacodynamics of midazolam following intravenous and intramuscular administration to sheep.

    Science.gov (United States)

    Simon, Bradley T; Scallan, Elizabeth M; O, Odette; Ebner, Lisa Sams; Cerullo, Michelle N; Follette, Christelle; Cox, Sherry K; Doherty, Thomas J; Lizarraga, Ignacio

    2017-05-01

    OBJECTIVE To determine the pharmacokinetic and pharmacodynamic effects of midazolam following IV and IM administration in sheep. ANIMALS 8 healthy adult rams. PROCEDURES Sheep were administered midazolam (0.5 mg/kg) by the IV route and then by the IM route 7 days later in a crossover study. Physiologic and behavioral variables were assessed and blood samples collected for determination of plasma midazolam and 1-hydroxymidazolam (primary midazolam metabolite) concentrations immediately before (baseline) and at predetermined times for 1,440 minutes after midazolam administration. Pharmacokinetic parameters were calculated by compartmental and noncompartmental methods. RESULTS Following IV administration, midazolam was rapidly and extensively distributed and rapidly eliminated; mean ± SD apparent volume of distribution, elimination half-life, clearance, and area under the concentration-time curve were 838 ± 330 mL/kg, 0.79 ± 0.44 hours, 1,272 ± 310 mL/h/kg, and 423 ± 143 h·ng/mL, respectively. Following IM administration, midazolam was rapidly absorbed and bioavailability was high; mean ± SD maximum plasma concentration, time to maximum plasma concentration, area under the concentration-time curve, and bioavailability were 820 ± 268 ng/mL, 0.46 ± 0.26 hours, 1,396 ± 463 h·ng/mL, and 352 ± 148%, respectively. Respiratory rate was transiently decreased from baseline for 15 minutes after IV administration. Times to peak sedation and ataxia after IV administration were less than those after IM administration. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated midazolam was a suitable short-duration sedative for sheep, and IM administration may be a viable alternative when IV administration is not possible.

  20. Observations on the use of midazolam for sedation, and induction of anaesthesia with midazolam in combination with ketamine in the goat

    Directory of Open Access Journals (Sweden)

    G.F. Stegmann

    1998-07-01

    Full Text Available Midazolam hydrochloride administered intramuscularly at a dosage of 0.4 mg/kg induced sedation and sternal recumbency in goats. Increasing the dosage to 1 mg/kg resulted in rapid onset of ataxia followed by lateral recumbency, and loss of consciousness. Light surgical anaesthesia lasted for a period of 7-15 min and was suitable for non-painful procedures. Heart rate was significantly increased (p < 0.05 at both dosage rates, while respiration rate was only increased after midazolam at 0.4 mg/kg. The combination of midazolam (0.4 mg/kg and ketamine hydrochloride (4 mg/kg increased heart and respiration rate significantly (p < 0.05. A light plane of surgical anaesthesia suitable for endotracheal intubation was induced, which lasted for a period of 16-39 min.

  1. Analgo-sedación consciente con midazolam y fentanilo oral transmucosa (OTFC en niños Conscious analgo-sedation with midazolam and fentanyl (OTFC in children

    Directory of Open Access Journals (Sweden)

    L. C. Álvarez-López

    2006-08-01

    Full Text Available Con elevada frecuencia, a los niños afectos de leucemias y otras enfermedades neoplásicas se les deben realizar una serie de pruebas diagnósticas y de tratamientos (punciones de médula ósea, administración intratecal de medicamentos… que producen dolor y que aumentan considerablemente el disconfort y sufrimiento o impiden la realización de las técnicas. La realización de técnicas de sedación consciente con fármacos utilizados por vía oral como el fentanilo (Citrato de Fentanilo Oral Transmucosa -OTFC- junto con midazolam, y el empleo de anestésico local en el lugar de punción, puede hacer que estas técnicas dolorosas sean bien toleradas por parte del paciente, evitando así el dolor y disminuyendo la angustia, el miedo y sufrimiento que representa para los niños la realización de cualquier prueba o tratamiento.Multiple bone marrow aspirations and lumbar punctures are performed on children with leukaemia and other neo-plastic disorders during the course of their illnesses. These procedures may give rise to considerable pain and distress in children. Fentanyl, a short-acting potent synthetic opioid, can produce sedation through oral transmucosal (Oral Transmucosal Fentanyl Citrate -OTFC- administration. The combination of OTFC and oral midazolam was a useful conscious sedation technique for painful procedures, such as lumbar punctures and bone marrow aspirations in this patients.

  2. Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

    Energy Technology Data Exchange (ETDEWEB)

    Stokland, E.; Jacobsson, B.; Ljung, B. [Dept. of Paediatric Radiology and Clinical Physiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Andreasson, S. [Dept. of Paediatric Anaesthesiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Jodal, U. [Dept. of Paediatrics, The Queen Silvia Children' s Hospital, Gothenburg (Sweden)

    2003-04-01

    Background: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. Objective: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. Materials and methods: The study was prospective, randomized and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. Results: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group (P < 0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo (NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. Conclusions: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination. (orig.)

  3. Midazolam inhibits the hypoxia-induced up-regulation of erythropoietin in the central nervous system.

    Science.gov (United States)

    Matsuyama, Tomonori; Tanaka, Tomoharu; Tatsumi, Kenichiro; Daijo, Hiroki; Kai, Shinichi; Harada, Hiroshi; Fukuda, Kazuhiko

    2015-08-15

    Erythropoietin (EPO), a regulator of red blood cell production, is endogenously expressed in the central nervous system. It is mainly produced by astrocytes under hypoxic conditions and has proven to have neuroprotective and neurotrophic effects. In the present study, we investigated the effect of midazolam on EPO expression in primary cultured astrocytes and the mouse brain. Midazolam was administered to 6-week-old BALB/c male mice under hypoxic conditions and pregnant C57BL/6N mice under normoxic conditions. Primary cultured astrocytes were also treated with midazolam under hypoxic conditions. The expression of EPO mRNA in mice brains and cultured astrocytes was studied. In addition, the expression of hypoxia-inducible factor (HIF), known as the main regulator of EPO, was evaluated. Midazolam significantly reduced the hypoxia-induced up-regulation of EPO in BALB/c mice brains and primary cultured astrocytes and suppressed EPO expression in the fetal brain. Midazolam did not affect the total amount of HIF proteins but significantly inhibited the nuclear expression of HIF-1α and HIF-2α proteins. These results demonstrated the suppressive effects of midazolam on the hypoxia-induced up-regulation of EPO both in vivo and in vitro.

  4. Comparison of Midazolam and Propofol for BIS-Guided Sedation During Regional Anaesthesia

    Directory of Open Access Journals (Sweden)

    Priyanka Khurana

    2009-01-01

    Full Text Available Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset& recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desired sedation, HR, MABP, time for recovery, dose to reach sedation and for maintenance of sedation and side effects if any. The time to reach required sedation was 11 min in Midazolam group(Group I while it was 6 min in Propofol group(Group II (p=0.0. Fall in MABP was greater with propofol. Recovery in with midazolam was slower than with propofol (18.6 ± 6.5 vs 10.10±3.65 min (p=0.00. We concluded that both midazolam and propofol are effective sedatives, but onset and offset was quicker with propofol, while midazolam was more cardiostable.

  5. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial

    Directory of Open Access Journals (Sweden)

    Katayoun Salem

    2015-01-01

    Full Text Available Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup.

  6. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy.

    Science.gov (United States)

    Hsu, Yen-Hsuan; Lin, Feng-Sheng; Yang, Chi-Cheng; Lin, Chih-Peng; Hua, Mau-Sun; Sun, Wei-Zen

    2015-06-01

    Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state. Copyright © 2013. Published by Elsevier B.V.

  7. INTRANASAL DEXMEDETOMIDINE VS. INTRANASAL MIDAZOLAM FOR PREMEDICATION OF PAEDIATRIC SURGERY PATIENTS

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    Revi N

    2016-06-01

    Full Text Available AIM Preoperative anxiety is one of the most common problems faced by anyone practising paediatric anaesthesia. Various drugs have been used in various routes to get a calm but cooperative child before induction of anaesthesia. Midazolam and dexmedetomidine have already proved their value in paediatric premedication. This study was conducted to compare the effects of these two drugs given intranasally. MATERIALS AND METHODS 100 children falling under the inclusion criteria were assigned to groups of 50 each. They received either intranasal midazolam 0.2 mg/kg (group M or intranasal dexmedetomidine 2 mcg/kg (Group D as premedication. They were compared with regards to the sedation status, anxiety levels and cardiovascular status every 10 minutes, at parental separation and at face mask application. RESULTS The mean sedation score obtained at all-time intervals, at parental separation and more importantly at mask induction were much lower for the midazolam group compared to the dexmedetomidine group. The mean anxiety levels, in general, were lower in the midazolam group, but they attained statistical significance only at 10 minutes and at mask induction. The heart rate measured up to 20 minutes after drug administration did not show much difference between both groups, but at 30 minutes, 40 minutes and at parental separation, heart rate was found to be lower in the dexmedetomidine group. CONCLUSION Intranasal dexmedetomidine and intranasal midazolam are equally effective in providing satisfactory parental separation, but intranasal midazolam produced superior conditions for mask acceptance than intranasal dexmedetomidine.

  8. Phenobarbital and midazolam increase neonatal seizure-associated neuronal injury.

    Science.gov (United States)

    Torolira, Daniel; Suchomelova, Lucie; Wasterlain, Claude G; Niquet, Jerome

    2017-07-01

    Status epilepticus is common in neonates and infants, and is associated with neuronal injury and adverse developmental outcomes. γ-Aminobutyric acidergic (GABAergic) drugs, the standard treatment for neonatal seizures, can have excitatory effects in the neonatal brain, which may worsen the seizures and their effects. Using a recently developed model of status epilepticus in postnatal day 7 rat pups that results in widespread neuronal injury, we found that the GABAA agonists phenobarbital and midazolam significantly increased status epilepticus-associated neuronal injury in various brain regions. Our results suggest that more research is needed into the possible deleterious effects of GABAergic drugs on neonatal seizures and on excitotoxic neuronal injury in the immature brain. Ann Neurol 2017;82:115-120. © 2017 American Neurological Association.

  9. Sedation and use of analgesics in endoscopic retrograde cholangiopancreatography: a double-blind comparison study of meperidine/midazolam, remifentanil/ midazolam, and remifentanil alone.

    Science.gov (United States)

    Zhang, Jinhua; Huang, Yong; Li, Zhao; Li, Jian; Liu, Kunpeng; Li, Chenghui

    2016-11-01

    To compare the efficacy and remifentanil with midazolam for conscious sedation during endoscopic retrograde cholangiopancreatography (ERCP). 99 patients scheduled for ERCP were randomly allocated to be treated with either meperidine/midazolam (group C, n = 33), remifentanil (group R, n = 33), or the remifentanil plus midazolam (group RM, n = 33). In group C, intermittent intravenous meperidine and midazolam were administrated during the procedure; in group R, remifentanil was infused continuously at a rate of 0.2 μg/kg/min for 5 minutes preoperatively, and decreased to 0.15 μg/kg/min when the procedure began; in group RM, midazolam 0.02 mg/kg was administered preoperatively, and remifentanil was administered in the same manner as in group R. Blood pressure, heart rate, respiratory rate, O2-saturation, and bispectral index (BIS) of the patients were recorded. The modified Aldrete scores, operator satisfaction scores, and side effects of the patients were noted as were the operative duration and anesthesia duration. The blood pressure of the patients were significantly increased in group R and group C compared to baseline, and no significant changes were noted in group RM. Group RM experienced the least variability in heart rate. BIS was decreased the most in groups C and RM. Hypoxemia was observed most frequently in group RM. Nausea and pain was highest in group C. Amnesia was most often reported in groups C and RM. Operator satisfaction and modified Aldrete of the patients was increased in group R. Both continuous remifentanil infusion alone and remifentanil plus midazolam provided satisfactory analgesia when used for sedation for ERCP, however, continuous remifentanil infusion alone resulted in increased operator satisfaction scores and expedited recoveryroom discharge.

  10. New anticonvulsant drugs. Focus on flunarizine, fosphenytoin, midazolam and stiripentol.

    Science.gov (United States)

    Bebin, M; Bleck, T P

    1994-08-01

    In the past decade, several new antiepileptic drugs have been tested. Most recently, 5 new antiepileptic drugs have been launched onto European and US markets. These include vigabatrin, oxcarbazepine and lamotrigine in Europe, and felbamate and gabapentin in the US. In addition to these, 3 additional drugs are in the clinical investigational stage: flunarizine, fosphenytoin and stiripentol. A fourth agent is midazolam, which was originally introduced in 1986, but recently has shown effectiveness in the treatment of status epilepticus. Flunarizine is a selective calcium channel blocker that has shown anticonvulsant properties in both animal and human studies. It is a long-acting anticonvulsant that clinical studies have shown to have effects similar to those of phenytoin and carbamazepine in the treatment of partial, complex partial and generalised seizures. Fosphenytoin was developed to eliminate the poor aqueous solubility and irritant properties of intravenous phenytoin. It is rapidly converted to phenytoin after intravenous or intramuscular administration. In clinical studies, this prodrug showed minimal evidence of adverse events and no serious cardiovascular or respiratory adverse reactions. It may have a clear advantage over the present parenteral formulation of phenytoin. Midazolam is a benzodiazepine that is more potent than diazepam as a sedative, muscle relaxant and in its influence on electroencephalographic measures. It has been shown to be an effective treatment for refractory seizures in status epilepticus. Stiripentol has anticonvulsant properties as well as the ability to inhibit the cytochrome P450 system. There are significant metabolic drug interactions between stiripentol and phenytoin, carbamazepine and phenobarbital (phenobarbitone). Stiripentol has been studied in patients with partial seizures, refractory epilepsy and refractory absence seizures with some efficacious results.

  11. A comparison of the sedative effect of oral versus nasal midazolam combined with nitrous oxide in uncooperative children.

    Science.gov (United States)

    Musani, I E; Chandan, N V

    2015-10-01

    To compare a combination of oral midazolam (0.2 mg/kg body weight) and nitrous oxide-oxygen sedation with a combination of intranasal midazolam (0.1 mg/kg body weight) and nitrous oxide-oxygen sedation for effectiveness, patient acceptability and safety profile in controlling the behaviour of uncooperative children. Thirty children, 4-10 years of age, referred for dental treatment were included in the study with a crossover design. Each patient was sedated with a combination of either oral midazolam and nitrous oxide-oxygen sedation or intranasal midazolam and nitrous oxide-oxygen sedation at subsequent dental treatment visits. During the treatment procedure, the study recorded scales for drug acceptability, onset of sedation, acceptance of nasal mask, sedation, behavioural, safety, overall behaviour and alertness. The grade of acceptability of midazolam in both groups was consistently good. There was a significant difference (p midazolam. The mean time of onset for oral midazolam was 20.1 (17-25) min and for intranasal midazolam 12.1 (8-18) min. The efficacy profile of the present study included: acceptance of nasal mask, sedation score, crying levels, motor movements and overall behaviour scores. The results did not show any statistically significant differences. All the parameters were highly satisfactory. The difference in alertness was statistically significant (p value midazolam. The intranasal route of midazolam administration has a quick onset of action and a quick recovery of the patient from sedation as compared to the oral route of midazolam administration. Midazolam administered through the intranasal route is as effective as the oral route at a lower dosage. Therefore, it is an effective alternative to oral route for a paediatric dental situation.

  12. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.

    Science.gov (United States)

    Ng, Eugene; Taddio, Anna; Ohlsson, Arne

    2017-01-31

    Proper sedation for neonates undergoing uncomfortable procedures may reduce stress and avoid complications. Midazolam is a short-acting benzodiazepine that is used increasingly in neonatal intensive care units (NICUs). However, its effectiveness as a sedative in neonates has not been systematically evaluated. Primary objeciveTo assess the effectiveness of intravenous midazolam infusion for sedation, as evaluated by behavioural and/or physiological measurements of sedation levels, in critically ill neonates in the NICU. Secondary objectivesTo assess effects of intravenous midazolam infusion for sedation on complications including the following.1. Incidence of intraventricular haemorrhage (IVH)/periventricular leukomalacia (PVL).2. Mortality.3. Occurrence of adverse effects associated with the use of midazolam (hypotension, neurological abnormalities).4. Days of ventilation.5. Days of supplemental oxygen.6. Incidence of pneumothorax.7. Length of NICU stay (days).8. Long-term neurodevelopmental outcomes. We selected for review randomised and quasi-randomised controlled trials of intravenous midazolam infusion for sedation in infants aged 28 days or younger. We abstracted data regarding the primary outcome of level of sedation. We assessed secondary outcomes such as intraventricular haemorrhage, periventricular leukomalacia, death, length of NICU stay and adverse effects associated with midazolam. When appropriate, we performed meta-analyses using risk ratios (RRs) and risk differences (RDs), and if the RD was statistically significant, we calculated the number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH), along with their 95% confidence intervals (95% CIs) for categorical variables, and weighted mean differences (WMDs) for continuous variables. We assessed heterogeneity by performing the I-squared (I2) test. We included in the review three trials enrolling 148 neonates. We identified no new trials for this update

  13. Effect of midazolam on the proliferation of neural stem cells isolated from rat hippocampus

    Institute of Scientific and Technical Information of China (English)

    Sanjun Zhao; Yajing Zhu; Rui Xue; Yunfeng Li; Hui Lu; Weidong Mi

    2012-01-01

    In many recent studies,the inhibitory transmitter gamma-aminobutyric acid has been shown to modulate the proliferation,differentiation and survival of neural stem cells.Most general anesthetics are partial or allosteric gamma-aminobutyric acid A receptor agonists,suggesting that general anesthetics could alter the behavior of neural stem cells.The neuroprotective efficacy of general anesthetics has been recognized for decades,but their effects on the proliferation of neural stem cells have received little attention.This study investigated the potential effect of midazolam,an extensively used general anesthetic and allosteric gamma-aminobutyric acid A receptor agonist,on the proliferation of neural stem cells in vitro and preliminarily explored the underlying mechanism.The proliferation of neural stem cells was tested using both Cell Counting Kit 8 and bromodeoxyuridine incorporation experiments.Cell distribution analysis was performed to describe changes in the cell cycle distribution in response to midazolam.Calcium imaging was employed to explore the molecular signaling pathways activated by midazolam.Midazolam (30-90 μM) decreased the proliferation of neural stem cells in vitro.Pretreatment with the gamma-aminobutyric acid A receptor antagonist bicuculline or Na-K-2Cl cotransport inhibitor furosemide partially rescued this inhibition.In addition,midazolam triggered a calcium influx into neural stem cells.The suppressive effect of midazolam on the proliferation of neural stem cells can be partly attributed to the activation of gamma-aminobutyric acid A receptor.The calcium influx triggered by midazolam may be a trigger factor leading to further downstream events.

  14. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements.

    Science.gov (United States)

    Steinlauf, A F; Garcia-Tsao, G; Zakko, M F; Dickey, K; Gupta, T; Groszmann, R J

    1999-04-01

    The hepatic venous pressure gradient (HVPG) is becoming increasingly used clinically. It is useful in the differential diagnosis of portal hypertension and provides a prognostic index in cirrhotic patients. Performance of serial measurements has been shown to be useful in guiding pharmacological therapy of portal hypertension and variceal hemorrhage. The technique is safe to perform; however, many patients are anxious and reluctant to undergo serial measurements. The effects of sedatives on portal pressure measurements have not yet been defined. The objective of this study was to evaluate the effects of midazolam on the HVPG. Twenty patients with compensated cirrhosis were included in this prospective, double-blind study. The HVPG was determined by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Patients were randomized to receive either placebo, 0.02 mg/kg midazolam, or 0.03 mg/kg midazolam, administered intravenously over 3 minutes. Immediately after drug administration and every 3 minutes thereafter, for a total of 30 or 40 minutes, measurements were repeated. Three hours later, patients were asked to state whether the sedative affected their state of comfort/relaxation. The effects of both doses of midazolam on HVPG did not differ significantly from those of placebo. Furthermore, neither dose of midazolam induced significant changes in HVPG as compared with baseline values. However, higher-dose midazolam (0.03 mg/kg) was associated with significant reductions in FHVP from baseline and a tendency for a reduction in WHVP. Both doses significantly increased patient comfort and relaxation during the test. Midazolam, used at a dose of 0.02 mg/kg, is effective in increasing patient comfort and relaxation during hepatic venous pressure measurements, without significantly affecting pressures (HVPG, WHVP, or FHVP). It is therefore an acceptable option for patients undergoing serial hepatic venous pressure measurements.

  15. MIDAZOLAM EFFICACY AND SIDE EFFECTS IN GENERALIZED AND PARTIAL REFRACTORY STATUS EPILEPTICUS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    M.R. Salehi Omran

    2009-04-01

    Full Text Available ObjectiveMidazolam is a significant and effective drug for control of a life-threatening condition, generalized and partial refractory convulsive status epilepticus. The goal of this study was evaluation of midazolam efficacy for management of this serious disease and its two side effects, hypotension and respiratory failure.Materials & MethodsOur study was done using a quasi experimental method; 22 children with generalized refractory convulsive status epilepticus and 13 with partial refractory convulsive status epilepticus were enrolled for the study. All patients received 0.2mg/kg/dose as a bolus intravenous midazolam followed by 1-6 mcg/kg/min continuous intravenous midazolam. Following this, termination of seizures as well as hypotension and respiratory failure were evaluated.ResultsMidazolam ceased stop convulsions in 81.81% (18 patients with generalized seizures, and in 76.92% (10 patients with partial seizures, showing no significant difference between these two types of seizures (p=0.52 Hypotension was induced in 18.18% (4 patients with generalized seizures and in 30.70% (4 patients with partial seizures, again difference not significant (p=0.14. There was respiratory failure in 21.73% (5 patients with generalized seizure and in 7.69% (1 patients with partial seizure, difference not significant.(p=0.09ConclusionThere was no significant difference in efficacy and creation of hypotension and respiratory failure after continuous intravenous infusion of midazolam between generalized and partial refractory convulsive status epilepticus.Key words:Midazolam, Refractory convulsive status epilepticus, Convulsive status epilepticus.

  16. Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy

    Science.gov (United States)

    Triant, Virginia A.; Ehrenfeld, Jesse M.; Lu, Zhigang; Arpino, Paul; Losina, Elena

    2014-01-01

    Summary Concerns regarding possible interactions between midazolam and antiretroviral medicines have caused clinicians to use second-line sedatives, such as diazepam, instead. We demonstrated that patients who received midazolam during colonoscopy had similar clinical outcomes as those who received diazepam. Background Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (IV) midazolam versus IV diazepam, a second-line agent, during colonoscopy. Methods We conducted a retrospective analysis of adult HIV-infected patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure, nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. Results We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (48 versus 45.7 minutes, P = 0.68), nadir systolic blood pressure (97 versus 101.6 mmHg, P = 0.06), nadir oxygen saturation (94.6 versus 94.8%, P = 0.72), or rate of abnormal cardiac rhythm (11.4 versus 19.7%, P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91 versus 74%, P = 0.0075), but no patient required reversal of sedation or became unresponsive. Conclusions Although IV midazolam interacts with ART, we did not find evidence that patients who received this agent for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be

  17. Efficacy and safety of intramuscular midazolam versus rectal diazepam in controlling status epilepticus in children.

    Science.gov (United States)

    Momen, Ali Akbar; Azizi Malamiri, Reza; Nikkhah, Ali; Jafari, Maryam; Fayezi, Abbas; Riahi, Kourosh; Maraghi, Elham

    2015-03-01

    The aim of this study was to evaluate the efficacy and safety of intramuscular midazolam in controlling convulsive status epilepticus in children, by comparing it with rectal diazepam. In this randomized trial, 100 children (50 in each group) with convulsive status epilepticus aged 1 month to 16 years were enrolled and randomly assigned into two groups to receive either 0.3 mg/kg intramuscular midazolam or 0.5 mg/kg rectal diazepam. Main outcome measure was stopping of all motor activity after drug administration. Another measures were times between patient's arrival to emergency department till drug administration, between drug administration to seizure cessation, and between patient's arrival to seizure cessation. Both medication were effective for seizure control and no significant difference was found between successful treatments after administering the medication (P = 0.061). In the midazolam group, in 96% (48/50) of cases treatment was successful and in the diazepam group, in 94% (47/50) of cases treatment was successful. Time from arrival to administering the medication was significantly shorter in midazolam group (P = 0.017). The majority of seizures in midazolam group were stopped in less than 66 s (median) compared to 130 s (median) for diazepam group, (P midazolam is not superior but may be at least as effective as rectal diazepam for controlling of status epilepticus in children. Midazolam via IM route could be one of the choices in children with convulsive status seizures who have difficult IV access. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  18. Anesthetic drug midazolam inhibits cardiac human ether-à-go-go-related gene channels: mode of action.

    Science.gov (United States)

    Vonderlin, Nadine; Fischer, Fathima; Zitron, Edgar; Seyler, Claudia; Scherer, Daniel; Thomas, Dierk; Katus, Hugo A; Scholz, Eberhard P

    2015-01-01

    Midazolam is a short-acting benzodiazepine that is in wide clinical use as an anxiolytic, sedative, hypnotic, and anticonvulsant. Midazolam has been shown to inhibit ion channels, including calcium and potassium channels. So far, the effects of midazolam on cardiac human ether-à-go-go-related gene (hERG) channels have not been analyzed. The inhibitory effects of midazolam on heterologously expressed hERG channels were analyzed in Xenopus oocytes using the double-electrode voltage clamp technique. We found that midazolam inhibits hERG channels in a concentration-dependent manner, yielding an IC50 of 170 μM in Xenopus oocytes. When analyzed in a HEK 293 cell line using the patch-clamp technique, the IC50 was 13.6 μM. Midazolam resulted in a small negative shift of the activation curve of hERG channels. However, steady-state inactivation was not significantly affected. We further show that inhibition is state-dependent, occurring within the open and inactivated but not in the closed state. There was no frequency dependence of block. Using the hERG pore mutants F656A and Y652A we provide evidence that midazolam uses a classical binding site within the channel pore. Analyzing the subacute effects of midazolam on hERG channel trafficking, we further found that midazolam does not affect channel surface expression. Taken together, we show that the anesthetic midazolam is a low-affinity inhibitor of cardiac hERG channels without additional effects on channel surface expression. These data add to the current understanding of the pharmacological profile of the anesthetic midazolam.

  19. Characterization of midazolam metabolism in locusts: the role of a CYP3A4-like enzyme in the formation of 1'-OH and 4-OH midazolam.

    Science.gov (United States)

    Olsen, Line Rørbæk; Gabel-Jensen, Charlotte; Wubshet, Sileshi Gizachew; Kongstad, Kenneth Thermann; Janfelt, Christian; Badolo, Lassina; Hansen, Steen Honoré

    2016-01-01

    1. The metabolism of midazolam was investigated in vivo in locusts in order to evaluate the presence of an enzyme with functionality similar to human CYP3A4/5. 2. Hydroxylated metabolites of midazolam identical to human metabolites were detected in locusts and the apparent affinities (Km values) were in the same range as reported in humans (in locusts: 7-23 and 33-85 µM for the formation of the 1'-OH and 4-OH metabolites, respectively). 3. The formation of hydroxylated metabolites could successfully be inhibited by co-administration of ketoconazole, a known CYP3A4/5 inhibitor. 4. Besides phase I metabolites, a number of conjugated metabolites were detected using high-resolution mass spectrometry. The most abundant metabolites detected were structurally identified by (1)H NMR as two N-glucosides. NMR analysis strongly suggested that the glycosylation occurred at the two nitrogens (either one in each case) of the imidazole ring. 5. Distribution of midazolam and the glucose conjugates were successfully measured using desorption electrospray mass spectrometry imaging revealing time-dependent changes in distribution over time. 6. In conclusion, it appears that an enzyme with functionality similar to human CYP3A4/5 is present in locusts. However, it appears that conjugation with glucose is the main detoxification pathway of midazolam in locusts.

  20. Epileptic manifestations induced by midazolam in the neonatal period Manifestações epilépticas induzidas por midazolam no período neonatal

    Directory of Open Access Journals (Sweden)

    Maria Augusta Montenegro

    2001-06-01

    Full Text Available Antiepileptic drugs may cause worsening of epilepsy by aggravating pre-existing seizures or by triggering new seizure types. There are several reports of adverse effects related to midazolam, but only a few authors reported epileptic manifestations. We report four newborns seen at the Neonatal Intensive Care Unit of our University Hospital, who developed seizures a few seconds after the administration of midazolam. It is difficult to identify the patients at risk, but it is important to be aware and recognize this situation.Drogas antiepilépticas podem piorar o controle da epilepsia por agravar crises epilépticas pre-existentes ou por desencadear novos tipos de crises. Existem vários relatos de eventos adversos relacionados ao midazolam; entretanto, poucos autores referem manifestações epilépticas. Neste estudo relatamos a ocorrência de crises epilépticas poucos segundos após a administração de midazolam, em quatro neonatos atendidos na Unidade de Terapia Intensiva do nosso hospital universitário. É difícil determinar quais pacientes estão em risco, mas é importante estar atento e reconhecer esta situação.

  1. The effects of concurrent atorvastatin therapy on the pharmacokinetics of intravenous midazolam.

    LENUS (Irish Health Repository)

    Mc Donnell, C G

    2012-02-03

    Midazolam is a commonly used anaesthetic agent and is metabolised by the 3A4 isoform of the cytochrome P450 enzyme system. Atorvastatin is also metabolised by cytochrome P450 3A4 and, in vitro, atorvastatin inhibits the cytochrome P450 3A4-mediated metabolism of mexazolam. We hypothesised that concurrent administration of atorvastatin and midazolam would result in altered midazolam pharmacokinetics. Fourteen patients scheduled to undergo general anaesthesia for elective surgery were recruited in a matched pair design to receive intravenous midazolam (0.15 mg.kg-1). Of these patients, seven were taking long-term atorvastatin. Atorvastatin patients demonstrated a greater area under the curve (889.4 (standard deviation 388.6) ng-h.ml-1) vs. control patients (629.1 (standard deviation 197.2) ng-h.ml-1) (p < 0.05). Patients taking atorvastatin also demonstrated a decreased clearance (0.18 (standard deviation 0.08) l-kg. h-1) vs. control patients (0.27 (standard deviation 0.08) l-kg.h-1) (p < 0.05). This study suggests that chronically administered atorvastatin decreases the clearance of intravenously administered midazolam.

  2. Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study.

    Science.gov (United States)

    Lightdale, Jenifer R; Valim, Clarissa; Newburg, Adrienne R; Mahoney, Lisa B; Zgleszewski, Steven; Fox, Victor L

    2008-06-01

    Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency. To compare the efficiency of propofol versus midazolam and fentanyl by measuring elapsed times between initial intravenous administration and patient discharge at a pediatric teaching hospital. Endoscopy times were prospectively collected for consecutive patients who were undergoing either anesthesiologist-administered propofol or endoscopist-administered midazolam and fentanyl. The effect of the type of sedation on these times was assessed by using multiple linear regression by adjusting for other candidate predictors, including concomitant use of other sedatives, endotracheal intubation by anesthesiologists, and the presence of fellow trainees. Time to onset of sedation (time sedation started to scope in), procedure time (endoscope in to endoscope out), discharge time (endoscope out to hospital discharge), and total time (sedation started to hospital discharge). The times for 134 children (mean age 12 +/- 5 years) to receive propofol sedation were compared with those of 195 children (13 +/- 5 years) who received midazolam and fentanyl. Midazolam and fentanyl cases disproportionately included EGDs (P propofol had shorter times until sedated, similar procedure times, longer discharge times, and comparable total times. Multivariate analyses confirmed that fellow participation prolonged the procedure times (P propofol times (P propofol sedation in a pediatric teaching endoscopy unit may not lead to faster hospital times when compared with endoscopist-administered midazolam and fentanyl. These results are not explained by controlling for patient characteristics, the presence of a trainee, the sedative doses, or endotracheal intubation for airway management.

  3. Midazolam premedication in children: a pilot study comparing intramuscular and intranasal administration.

    Science.gov (United States)

    Lam, Christy; Udin, Richard D; Malamed, Stanley F; Good, David L; Forrest, Jane L

    2005-01-01

    The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation. Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated. The patients ranged in age from 2 to 9 years (mean age, 5.13 years) and were randomly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration. All patients received 50% nitrous oxide and 50% oxygen inhalation sedation and local anesthetic (0.2 mL of 4% prilocaine hydrochloride) before venipuncture. The sedation level, movement, and crying were evaluated at the following time points: 10 minutes after drug administration and at the times of parental separation, passive papoose board restraint, nitrous oxide nasal hood placement, local anesthetic administration, and initial venipuncture attempt. Mean ratings for the behavioral parameters of sedation level, degree of movement, and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points. Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration. Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation.

  4. COMPARING EFFECTIVENESS OF ORAL AND INTRANASAL MIDAZOLAM FOR PREMEDITATION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    P SAJEDI

    2000-03-01

    Full Text Available Background. Preoperative evaluation and psychological preparation is important before anesthesia. Children are very dependent to their parents, specially before 5 years. Anesthesiologist must administer anxiolytic and sedative drugs before separation from parents as premeditation. The aim of this study is comparison survey on effect of oral midazolam and intranasal midazolam in children 1 to 5 years as premeditation. Methods. In a clinical trial study performed through first half of 1377 at St. Alzahra Center (Isfahan University of Medicine, sixty healthy children in first class of ASA who had non gastrointestinal elective surgery were studied. Group one consisted of thirty children who received intravenous form midazolam (0.5 mg/kg with fruit juice orally 45 to 60 minutes before operation. Group 2 consisted of thirty children who received midazolam (IV form 0.2 mg/kg intranasally 15 minutes before operation. Findings. Anxiety was less in first group during administration of drug. Forty four percent were quiet in this group (P < 0.005. Seventy six percent of children who well accepted the drug, were in the first group (P < 0.005. There was no significant statistical difference between two groups in other aspects of study. Conclusion. Oral administration of midazolam has better acceptance in children than intranasal with less anxiety.

  5. A comparison of midazolam and clonidine as an oral premedication in pediatric patients

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    Sequeira Trevor

    2012-01-01

    Full Text Available Background: To compare oral midazolam (0.5 mg/kg versus oral clonidine (4 μg/kg as a premedication in pediatric patients aged between 2-12 years with regard to sedation and anxiolysis. Methods: Sixty pediatric patients belonging to the American Society of Anesthesiologists class I and II between the age group of 2-12 years scheduled for elective surgery were randomly allocated to receive either oral midazolam (group I 30 min before induction or oral clonidine (group II 90 min before induction of anesthesia. The children were evaluated for levels of sedation and anxiety at the time of separation from the parents, venepuncture, and at the time of mask application for induction of anesthesia. Results: After premedication, the percentage of children who were sedated and calm increased in both the groups. The overall level of sedation was better in the children in the clonidine group, but children in the midazolam group had a greater degree of anxiolysis at times of venepuncture and mask application. In addition, midazolam did not cause significant changes in hemodynamics unlike clonidine where a significant fall in blood pressure was noted, after premedication, but preinduction. Conclusion: We conclude that under the conditions of the study, oral midazolam is superior to clonidine as an anxiolytic in pediatric population. Clonidine with its sedative action especially at the time of separation from parents along with its other perioperative benefits cannot be discounted.

  6. COMPARATIVE EVALUATION OF ORAL MIDAZOLAM, BUTORPHANOL AND CLONIDINE AS PREMEDICANTS IN CHILDREN UNDERGOING ELECTIVE SURGERY

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    Mukta

    2015-06-01

    Full Text Available BACKGROUND: We compared the effects of oral midazolam, butorphanol and clonidine on preoperative sedation and anxiolysis and postoperative recovery profile of the children undergoing elective surgery. MATERIAL AND METHODS : 105 children of either sex, aged between 2 - 6 years, of ASA grade I scheduled for elective surgery were randomized into three groups. Group I: 35 children received midazolam 0.5 mg/kg body weight orally, Group II: 35 children received butorphanol 0.2 mg/kg orally, Group III: 35 children received cloni dine 4 μ/kg orally. Premedication was given 30 minutes before induction of anaesthesia. Children were assessed for attitude to venepuncture and face mask acceptance during induction of anaesthesia. RESULTS: The groups were statistically comparable (p>0.05 , regarding the patients’ demographic profile, hemodynamic variables, duration of surgery and awakening. Less time was required for the onset and time of maximum sedation in midazolam group. Sedation scores were highest in the clonidine group at the time o f induction (p0.05 and minimal with butorphanol. Reaction to i.v cannulation was minimal with clonidine whi le it was comparable in midazolam and butorphanol group. CONCLUSION: clonidine causes the best sedation among the three drugs and it causes minimum response to i.v cannulation and comparable mask acceptance with midazolam followed by butorphanol.

  7. Effect of brivaracetam on CYP3A activity, measured by oral midazolam.

    Science.gov (United States)

    Stockis, Armel; Watanabe, Shikiko; Scheen, André J

    2015-05-01

    Brivaracetam is a synaptic vesicle protein 2A ligand in phase III development for epilepsy. A phase I, open-label, randomized study was conducted in 42 healthy male participants to assess the effect of brivaracetam on CYP3A activity using midazolam as a probe. Participants were randomized to oral brivaracetam 5, 50, or 150 mg/day from Day 8 to Day 14. A single oral dose (7.5 mg) of midazolam was administered on Days 1, 13, and 20, and full pharmacokinetic profiles were obtained. For all brivaracetam doses, the areas under the plasma concentration-time curves from 0 to infinity (AUCinf ) for midazolam and 1'-hydroxymidazolam were similar on Days 13 and 20 compared with Day 1. Following brivaracetam 150 mg/day, the Day 13/Day 1 AUCinf ratio (90% confidence interval) was 1.09 (0.97, 1.21) and 1.04 (0.93, 1.17) for midazolam and 1'-hydroxymidazolam, respectively. For the Day 20/Day 1 comparison, the corresponding AUCinf ratios were 1.10 (0.98, 1.23) and 1.07 (0.97, 1.18). Maximum midazolam plasma concentration was increased on both Day 13 and Day 20 vs. Day 1 but the relevance of this finding was unclear. This study indicates that brivaracetam up to 150 mg/day has no significant inducing or inhibiting effect on CYP3A activity.

  8. Mechanistic Modeling to Predict Midazolam Metabolite Exposure from In Vitro Data.

    Science.gov (United States)

    Nguyen, Hoa Q; Kimoto, Emi; Callegari, Ernesto; Obach, R Scott

    2016-05-01

    Methods to predict the pharmacokinetics of drugs in humans from in vitro data have been established, but corresponding methods to predict exposure to circulating metabolites are unproven. The objective of this study was to use in vitro methods combined with static and dynamic physiologically based pharmacokinetic (PBPK) models to predict metabolite exposures, using midazolam and its major metabolites as a test system. Intrinsic clearances (CLint) of formation of individual metabolites were determined using human liver microsomes. Metabolic CLintof hydroxymidazolam metabolites via oxidation and glucuronidation were also determined. Passive diffusion intrinsic clearances of hydroxymidazolam metabolites were determined using sandwich cultured human hepatocytes and the combination of this term along with the metabolic CLint, and liver blood flow was used to estimate the fraction of the metabolite that can enter the systemic circulation after formation in the liver. The metabolite/parent drug area under the plasma concentration-time curve ratio (AUCm/AUCp) was predicted using a static model relating the fraction of midazolam clearance to each metabolite, the clearance rates of midazolam and hydroxymidazolam metabolites, and the availability of the metabolites. Additionally, the human disposition of midazolam metabolites was simulated using a SimCYP PBPK model. Both approaches yielded AUCm/AUCpratios that were in agreement with the in vivo ratios. This study shows that in vivo midazolam metabolite exposure can be predicted from in vitro data and PBPK modeling. This study emphasized the importance of metabolite systemic availability from its tissue of formation, which remains a challenge to quantitative prediction.

  9. Is midazolam superior to triclofos and hydroxyzine as premedicant in children?

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    Sujata Chaudhary

    2014-01-01

    Full Text Available Background: Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries. Materials and Methods: Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed. Results: The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed. Conclusion: Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.

  10. Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients

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    Chandni Sinha

    2012-01-01

    Full Text Available Background: To compare oral midazolam (0.5 mg/kg with oral butorphanol (0.2 mg/kg as a premedication in 60 pediatric patients with regards to sedation, anxiolysis, rescue analgesic requirement, and recovery profile. Materials and Methods: In a double blinded study design, 60 pediatric patients belonging to ASA class I and II between the age group of 2-12 years scheduled for elective surgery were randomized to receive either oral midazolam (group I or oral butorphanol (group II 30 min before induction of anesthesia. The children were evaluated for levels of sedation and anxiety at the time of separation from the parents, venepuncture, and at the time of facemask application for induction of anesthesia. Rescue analgesic requirement, postoperative recovery, and complications were also recorded. Results: Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents. Midazolam proved to be a better anxiolytic during venepuncture and facemask application. Butorphanol reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea, vomiting, or unpleasant postoperative recovery. Conclusion: Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties. It does not increase side effects significantly.

  11. Efficacy of midazolam as oral premedication in children in comparison to triclofos sodium

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    Kolathu Parambil Radhika

    2016-01-01

    Full Text Available Background and Aims: The perioperative behavioural studies demonstrate that children are at greater risk of experiencing turbulent anaesthetic induction and adverse behavioural sequelae. We aimed to compare the efficacy of midazolam 0.5 mg/kg with triclofos sodium 100 mg/kg as oral premedication in children undergoing elective surgery. Methods: In this prospective, randomised and double-blind study, sixty children posted for elective lower abdominal surgery were enrolled. The patients were randomly divided into midazolam group (Group M and triclofos sodium group (Group T of thirty each. Group M received oral midazolam 0.5 mg/kg 30 min before induction, and Group T received oral triclofos sodium 100 mg/kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. Mann–Whitney U-test was used for comparing the grade of sedation, ease of separation and acceptance of face mask. Results: Oral midazolam produced adequate sedation in children after premedication in comparison to oral triclofos (P = 0.002. Both drugs produced successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. Conclusions: Oral midazolam is superior to triclofos sodium as a sedative anxiolytic in paediatric population.

  12. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children.

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    Ashrafi, Mahmoud Reza; Khosroshahi, Nahid; Karimi, Parviz; Malamiri, Reza Azizi; Bavarian, Behrouz; Zarch, Anoushiravan Vakili; Mirzaei, Mehdi; Kompani, Farshid

    2010-09-01

    A Prolonged convulsive seizure is the most common neurological medical emergency with poor outcome. An ideal anticonvulsant should be easy-to-use, effective, and safe, and it should also have a long-lasting effect. Benzodiazepines, give via the intravenous or rectal route have generally been used as first-line drugs. In small children, IV access can be difficult and time consuming. Midazolam is a potent anticonvulsant and is rapidly absorbed from the rectal, nasal, and buccal mucosa. Our aim was to evaluate the efficacy and usability of buccal midazolam in controlling seizures in children with acute prolonged seizures, by comparing it with rectal diazepam. Ninety-eight patients were enrolled, with 49 patients in each treatment group. In the buccal midazolam group, 42 (88%) patients were controlled in less than 4 min of drug administration, and all of the patients were controlled within 5 min of drug administration. In the rectal diazepam group, 24 (49%) patients were controlled in less than 4 min and 40 (82%) patients were controlled within 5 min of drug administration. The time for drug administration and drug effect was significantly less with buccal midazolam than with rectal diazepam (p valuediazepam group, 7 (14%) parents were satisfied. Buccal midazolam was significantly more acceptable than rectal diazepam (p valuediazepam but more convenient to use in the controlling acute prolonged seizures in children, especially in situations in which there is a difficulty in gaining IV access, for example, in infants.

  13. A Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children

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    Mohammad Ghofrani

    2012-09-01

    Full Text Available Objective: The purpose of the present study is to compare efficacy and safety of buccal midazolam with intravenous diazepam in control of seizures in Iranian children.Methods: This is a randomized clinical trial. 92 patients with acute seizures, ranging from 6 months to 14 years were randomly assigned to receive either buccal midazolam (32 cases or intravenous diazepam (60 cases at the emergency department of a children's hospital. The primary outcome of this study was cessation of visible seizure activity within 5 minutes from administration of the first dosage. The second dosage was used in case the seizure remained uncontrolled 5 minutes after the first one.Findings: In the midazolam group, 22 (68.8% patients were relieved from seizures in 10 minutes.Meanwhile, diazepam controlled the episodes of 42 (70% patients within 10 minutes. The difference was,however, not statistically significant (P=0.9. The mean time required to control the convulsive episodes after administration of medications was not statistically significant (P=0.09. No significant side effects were observed in either group. Nevertheless, the risk of respiratory failure in intravenous diazepam is greater than in buccal midazolam.Conclusion: Buccal midazolam is as effective as and safer than intravenous diazepam in control of seizures.

  14. Midazolam Premedication in Children: A Pilot Study Comparing Intramuscular and Intranasal Administration

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    Lam, Christy; Udin, Richard D; Malamed, Stanley F; Good, David L; Forrest, Jane L

    2005-01-01

    The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation. Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated. The patients ranged in age from 2 to 9 years (mean age, 5.13 years) and were randomly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration. All patients received 50% nitrous oxide and 50% oxygen inhalation sedation and local anesthetic (0.2 mL of 4% prilocaine hydrochloride) before venipuncture. The sedation level, movement, and crying were evaluated at the following time points: 10 minutes after drug administration and at the times of parental separation, passive papoose board restraint, nitrous oxide nasal hood placement, local anesthetic administration, and initial venipuncture attempt. Mean ratings for the behavioral parameters of sedation level, degree of movement, and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points. Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration. Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation. PMID:16048152

  15. Memory and hippocampal architecture following short-term midazolam in western diet-treated rats.

    Science.gov (United States)

    Rosenberger, Dorothea S; Falangola, Maria F; Ledreux, Aurélie; Nie, Xingju; Suhre, Wendy M; Boger, Heather A; Granholm, Ann-Charlotte

    2016-05-16

    The impact of short-term benzodiazepine exposure on cognition in middle-aged or older patients is a highly debated topic among anesthesiologists, critical care physicians and public media. "Western diet" (WD) consumption is linked to impaired cognition as well. The combination of benzodiazepines with substantial exposure to WD might set the stage for increased hippocampal vulnerability for benzodiazepines leading to exaggerated cognitive impairment in the postoperative period. In this study, Fischer 344 rats were fed either WD or standard rodent diet from 5 to 10.5 months of age. Rats were exposed to midazolam or placebo two days prior to an MRI scan using Diffusional Kurtosis Imaging (DKI) to assess brain microstructural integrity, followed by behavioral testing using a water radial arm maze. Hippocampal tissue was collected to assess alterations in protein biochemistry in brain regions associated with learning and memory. Our results showed that rats exposed to the combination of midazolam and WD had significantly delayed time of learning and exhibited spatial memory impairment. Further, we observed an overall increase of kurtosis metrics in the hippocampus and increased expression of the mitochondrial protein VDAC2 in midazolam-treated rats. Our data suggest that both the short-acting benzodiazepine midazolam and WD contribute to negatively affect the brain in middle-aged rats. This study is the first application of DKI on the effects of midazolam and WD exposure, and the findings demonstrate that diffusion metrics are sensitive indicators of changes in the complexity of neurite architecture.

  16. Efficacy of midazolam as oral premedication in children in comparison to triclofos sodium.

    Science.gov (United States)

    Radhika, Kolathu Parambil; Sreejit, Melveetil S; Ramadas, Konnanath T

    2016-06-01

    The perioperative behavioural studies demonstrate that children are at greater risk of experiencing turbulent anaesthetic induction and adverse behavioural sequelae. We aimed to compare the efficacy of midazolam 0.5 mg/kg with triclofos sodium 100 mg/kg as oral premedication in children undergoing elective surgery. In this prospective, randomised and double-blind study, sixty children posted for elective lower abdominal surgery were enrolled. The patients were randomly divided into midazolam group (Group M) and triclofos sodium group (Group T) of thirty each. Group M received oral midazolam 0.5 mg/kg 30 min before induction, and Group T received oral triclofos sodium 100 mg/kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. Mann-Whitney U-test was used for comparing the grade of sedation, ease of separation and acceptance of face mask. Oral midazolam produced adequate sedation in children after premedication in comparison to oral triclofos (P = 0.002). Both drugs produced successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. Oral midazolam is superior to triclofos sodium as a sedative anxiolytic in paediatric population.

  17. Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

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    Tschirch, Frank T.C.; Goepfert, Kerstin; Brunner, Genevieve; Weishaupt, Dominik [University Hospital Zuerich, Institute of Diagnostic Radiology, Zuerich (Switzerland); Froehlich, Johannes M. [Klus-Apotheke, Zuerich (Switzerland)

    2007-06-15

    The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (p<0.001). Low-dose intranasal midazolam is an effective and patient-friendly solution to overcome anxiety in claustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form. (orig.)

  18. Subcutaneous Midazolam with and without Ketamine for Sedation In Children Undergoing Dental Treatment: A Pilot Study.

    Science.gov (United States)

    Flores-Castillo, D; Martínez-Rider, R; Ruiz-Rodríguez, S; Garrocho-Rangel, A; Lara-Guevara, J; Pozos-Guillén, A

    2015-01-01

    The objective of this study was to evaluate the efficacy of subcutaneous (SC) sedation using midazolam with and without ketamine in non-cooperative pediatric patients undergoing dental treatment. A prospective, randomized, controlled, double-blind, crossover pilot clinical trial was carried out in 13 children, aged between 17-46 months, ASA l, Frankl 1. Two sedation schemes were administered SC: Midazolam alone (M), and a combination of Midazolam-Ketamine (MK). Both regimens were administered to the same patient in two consecutive treatment sessions, in accordance with a random assignment. Overall behavior, movement, and crying were assessed according to the modified Houpt scale. Heart rate, blood pressure, blood oxygen saturation, and possible side effects were also monitored. The percentage of non-crying children was always higher in the treatment with MK compared with the treatment with M, but without a significant statistical difference. Regarding variable body movement, the percentage of children without movement was higher in the MK group, although only up to minute 10; no significant differences were found at 20, 30, and 40 minutes, and from minute 40, body movement was lower in the M group. Midazolam alone and the midazolam-ketamine combination administered subcutaneously resulted in a safe and efficient pharmacological method for providing moderate sedation to non-cooperative pediatric patients undergoing dental treatment.

  19. Effect of pretreatment with midazolam on etomidate-induced myoclonus: A meta-analysis.

    Science.gov (United States)

    Zhou, Chengmao; Zhu, Yu; Liu, Zhen; Ruan, Lin

    2017-04-01

    Objective To investigate the effect of pretreatment with midazolam on myoclonus induced by etomidate injection. Methods A meta-analysis was performed using Review Manager software, version 5.2. Two researchers independently searched PubMed, Cochrane Library, and Embase® databases for randomized controlled trials involving patients who underwent etomidate induced general anaesthesia with or without midazolam pretreatment, published between 1990 and 2016. Outcome measures comprised overall myoclonus incidence rate and incidence rate classified by degree of myoclonus following etomidate injection. Data were assessed using a fixed effects model. Results Five studies, comprising 302 patients, were included for analysis. Overall incidence rate of etomidate injection-induced myoclonus was significantly lower in the pooled midazolam group versus controls (relative risk [RR] 0.34, 95% confidence interval [CI] 0.26, 0.44); Results subgrouped by degree of myoclonus showed significantly lower incidence in midazolam groups versus control groups for mild myoclonus (RR 0.56, 95% CI 0.39, 0.80); moderate myoclonus (RR 0.20, 95% CI 0.10, 0.41); and severe myoclonus (RR 0.12, 95% CI 0.04, 0.39). Conclusion Midazolam can effectively prevent etomidate-induced myoclonus, and alleviate the degree of etomidate-induced myoclonus.

  20. TRPM7 channel inhibition mediates midazolam-induced proliferation loss in human malignant glioma.

    Science.gov (United States)

    Chen, Jingkao; Dou, Yunling; Zheng, Xiaoke; Leng, Tiandong; Lu, Xiaofang; Ouyang, Ying; Sun, Huawei; Xing, Fan; Mai, Jialuo; Gu, Jiayu; Lu, Bingzheng; Yan, Guangmei; Lin, Jun; Zhu, Wenbo

    2016-11-01

    The melastatin-like transient receptor potential 7 (TRPM7) has been implicated in proliferation or apoptosis of some cancers, indicating the potential of TRPM7 as an anti-anaplastic target. Here, we identified the characteristic TRPM7 channel currents in human malignant glioma MGR2 cells, which could be blocked by a pharmacologic inhibitor Gd(3+). We mined the clinical sample data from Oncomine Database and found that human malignant glioma tissues expressed higher TRPM7 mRNA than normal brain ones. Importantly, we identified a widely used clinical anesthetic midazolam as a TRPM7 inhibitor. Midazolam treatment for seconds suppressed the TRPM7 currents and calcium influx, and treatment for 48 h inhibited the TRPM7 expression. The inhibitory effect on TRPM7 accounts for the proliferation loss and G0/G1 phase cell cycle arrest induced by midazolam. Our data demonstrates that midazolam represses proliferation of human malignant glioma cells through inhibiting TRPM7 currents, which may be further potentiated by suppressing the expression of TRPM7. Our result indicates midazolam as a pharmacologic lead compound with brain-blood barrier permeability for targeting TRPM7 in the glioma.

  1. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.

    Science.gov (United States)

    Barends, Clemens R M; Absalom, Anthony; van Minnen, Baucke; Vissink, Arjan; Visser, Anita

    2017-01-01

    To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications. We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar. Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.

  2. Analogosedation during flexible bronchoscopy using a combination of midazolam, propofol and fentanyl - A retrospective analysis.

    Science.gov (United States)

    Müller, Tobias; Thümmel, Kristina; Cornelissen, Christian G; Krüger, Stefan; Dreher, Michael

    2017-01-01

    According to current guidelines flexible bronchoscopy is usually performed under sedation. Previously it has been demonstrated that combined sedation with e. g. the combination of midazolam and propofol or an opioid might have several advantages over sedation with just one sedative drug. However, little is known about the efficacy and safety of combined sedation with midazolam, fentanyl and propofol (MFP) compared to sedation with midazolam and fentanyl (MF) or midazolam and propofol (MP). We carried out a retrospective analysis of bronchoscopies performed under triple (MFP) or double sedation (MF and MP) in an academic hospital. 1392 procedures were analyzed (MFP: n = 824; MF: n = 272; MP: n = 296). In particular, we compared the occurrence of complications and the dosage of administered sedative drugs between the groups. The occurrence of adverse events (MFP vs. MF: odds ratio (OR) 1.116 [95% CI 0.7741 to 1.604]; MFP vs. MP: OR 0.8296 [95% CI 0.5939 to 1.16] and severe adverse events (MFP vs. MF: OR 1.581 [95% CI 0.5594 to 4.336]; MFP vs. MP: OR 3.47 [95% CI 0.908 to 15.15]; all p>0.05) was similar in all groups. The dosage of midazolam was lower in the MFP compared to the MF or MP group (MFP vs. MF: Cohen's d 0.075; MFP vs. MP: Cohen's d 0.225; all pmidazolam and propofol.

  3. Melatonin versus midazolam premedication in children undergoing surgery: A pilot study.

    Science.gov (United States)

    Gitto, Eloisa; Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Crisafi, Caterina; Montalto, Angela Simona; Impellizzeri, Pietro; Reiter, Russel J; Romeo, Carmelo

    2016-03-01

    Melatonin has been proposed as a premedication alternative to midazolam, preceding anaesthesia induction. However, to our knowledge, data concerning interaction between melatonin and intravenous anaesthetic drugs in children are not available. The aim of this prospective, randomized, double-blind pilot study was to investigate the possible effect of melatonin premedication, in comparison to midazolam, on the required infusion of propofol in children undergoing surgery. As a secondary outcome, the effect of oral melatonin on the preoperative sedation level and on the post anaesthesia recovery score was evaluated. Children between the age of 5 and 14 years, scheduled for elective surgery, were prospectively enrolled between January 2012 and December 2013, and randomly assigned to two groups based on whether they received oral melatonin (0.5 mg/kg) or oral midazolam (0.5 mg/kg) premedication before induction of anaesthesia with propofol. Degree of sedation before and after anaesthesia was also evaluated. Ninety-two patients were studied, 46 for each group. We found that oral administration of melatonin significantly reduced doses of propofol required for induction of anaesthesia in paediatric patients, more than midazolam (P midazolam. These data support the use of melatonin as a premedicant in paediatric surgical patients. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  4. Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction

    Science.gov (United States)

    de Oliveira-Ribeiro, Artur; de Almeida-Souza, Liane-Maciel; Groppo, Francisco-Carlos

    2017-01-01

    Background Anxiety symptoms are frequently observed in dental patients, whether they are undergoing simple or more invasive procedures such as surgery. This research aimed to compare the effects of Passiflora incarnata and midazolam for the control of anxiety in patients undergoing mandibular third molar extraction. Material and Methods Forty volunteers underwent bilateral extraction of their mandibular third molars in a randomized, controlled, double-blind, crossover clinical trial. Passiflora incarnata (260 mg) or midazolam (15 mg) were orally administered 30 minutes before surgery. The anxiety level of participants was evaluated by questionnaires and measurement of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2). Results Considering each procedure independently, there were no significant differences between the protocols in BP, HR, and SpO2. Over 70% of the volunteers responded that they felt quiet or a little anxious under both protocols. With midazolam, 20% of the participants reported amnesia (not remembering anything at all), while Passiflora showed little or no ability to interfere with memory formation. Conclusions Passiflora incarnata showed an anxiolytic effect similar to midazolam, and was safe and effective for conscious sedation in adult patients who underwent extraction of their mandibular third molars. Key words:Passiflora incarnata, midazolam, anxiety, oral surgery. PMID:27918731

  5. Effect of carbamazepine or phenytoin therapy on blood level of intravenously administered midazolam: a prospective cohort study.

    Science.gov (United States)

    Hayashi, Tomoko; Higuchi, Hitoshi; Tomoyasu, Yumiko; Ishii-Maruhama, Minako; Maeda, Shigeru; Miyawaki, Takuya

    2016-02-01

    Dental treatment of intellectually disabled patients is frequently performed under general anesthesia or sedation. Many of these patients have epilepsy and are medicated with antiepileptic drugs (AEDs). Carbamazepine (CBZ) and phenytoin (PHT) are known to promote the metabolism of midazolam, and the blood levels of midazolam in patients medicated with CBZ or PHT may be different from those in healthy individuals. In this study, we clarified the influences of CBZ and PHT on the blood level of intravenously administered midazolam in patients medicated with CBZ or PHT. The subjects were divided into the following groups: not medicated with AEDs (control group), medicated with only CBZ or PHT (mono CBZ/PHT group), and medicated with CBZ or PHT or both and other AEDs (poly CBZ/PHT group). General anesthesia was achieved using midazolam, propofol, and remifentanil, and then the blood midazolam level was measured at 10, 30, and 60 min after intravenous midazolam administration. According to the results, the blood midazolam level was significantly lower in the mono and poly CBZ/PHT groups than in the control group. This finding suggests that intravenously administered midazolam may have a weaker effect in patients medicated with CBZ or PHT.

  6. Sedation and physiologic response to manual restraint after intranasal administration of midazolam in Hispaniolan Amazon parrots (Amazona ventralis).

    Science.gov (United States)

    Mans, Christoph; Guzman, David Sanchez-Migallon; Lahner, Lesanna L; Paul-Murphy, Joanne; Sladky, Kurt K

    2012-09-01

    Administration of intranasal midazolam (2 mg/kg) was evaluated for sedation and effects on cloacal temperature, respiratory rate, and heart rate in manually restrained Hispaniolan Amazon parrots (Amazona ventralis). Adult parrots (n=9) were administered either midazolam (2 mg/kg) or an equal volume of saline solution intranasally before a 15-minute manual restraint in a complete crossover study. Respiratory rate and sedation scores were recorded before and during capture and during and after 15 minutes of manual restraint. Heart rate and cloacal temperature were recorded during manual restraint. After restraint, the parrots received intranasal flumazenil (0.05 mg/kg) or an equal volume of saline solution, and the recovery time was recorded. In those birds that received midazolam, sedation was observed within 3 minutes of administration, and vocalization, flight, and defense responses were significantly reduced during capture. During manual restraint, the mean rate of cloacal temperature increase was significantly slower and remained significantly lower in birds that received midazolam compared with controls. Mean respiratory rates were significantly lower for up to 12 minutes in parrots that received midazolam compared with those receiving saline solution. Flumazenil antagonized the effects of midazolam within 10 minutes. No overt clinical adverse effects to intranasal midazolam and flumazenil administration were observed. Further studies on the safety of intranasal midazolam and flumazenil in this species are warranted.

  7. Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic.

    Science.gov (United States)

    Peerbhay, Fathima; Elsheikhomer, Ahmed Mahgoub

    2016-01-01

    The purpose of this study was to compare the effectiveness and recovery times of 0.3 and 0.5 mg/kg intranasal midazolam (INM) administered with a mucosal atomizer device (MAD) in a pediatric emergency dental hospital clinic. One hundred eighteen children aged from 4 to 6 years were randomly administered either 0.3 or 0.5 mg/kg INM via an MAD in a triple-blinded randomized controlled trial. Sedation was achieved to some degree in 100% of the sample. The pulse rate and oxygen saturation were within the normal range in 99% of the patients. A burning sensation was reported in 9% of children. The recovery time of the 0.5 mg/kg group was statistically longer than that of the 0.3 mg/kg group (16.5 vs 18.8 minutes) but the difference was not clinically significant. The findings of this study show that 0.3 or 0.5 mg/kg doses of INM resulted in safe and effective sedation. The 0.5 mg/kg dose was more effective than the 0.3 mg/kg dose in reducing anxiety.

  8. Anterograde amnesia as a possible postoperative complication of Midazolam as an agent for intravenous conscious sedation.

    Science.gov (United States)

    Malamed, S F; Nikchevich, D; Block, J

    1988-01-01

    Anterograde amnesia is often considered to be a beneficial effect of intravenous conscious sedation. The recently introduced benzodiazepine, midazolam, has associated with its administration a significant anterograde amnesic period. In the case presented here, a healthy young female presented for third molar extraction under midazolam conscious sedation and local anesthesia. After uncomplicated removal of the teeth and clinically adequate recovery from sedation, it was noted that the patient had swallowed the postsurgical gauze packs. Efforts at recovery of the gauze packs were futile. Follow-up discussion with the patient revealed a complete lack of recall of all events occurring for up to an hour or more after the administration of intravenous midazolam. The need for written and oral postoperative instructions to both the patient and his/her escort is emphasized.

  9. Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients

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    Schlief Hans-Eugen

    2010-01-01

    Full Text Available Abstract Background Although gastrointestinal endoscopy with sedation is increasingly performed in elderly patients, data on combined sedation with midazolam/propofol are very limited for this age group. Methods We retrospectively analyzed 454 endoscopic procedures in 347 hospitalized patients ≥ 70 years who had received combined sedation with midazolam/propofol. 513 endoscopic procedures in 397 hospitalized patients Results Elderly patients had a higher level of co-morbidity and needed lower mean propofol doses for sedation. We observed no major complication and no difference in the number of minor complications. The procedure-associated mortality was 0%; the 28-day mortality was significantly higher in the elderly (2.9% vs. 1.0%. Conclusions In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam/propofol with a higher sensitivity to propofol in the elderly.

  10. [Premedication in children: a comparison of oral midazolam and rectal bromazepam].

    Science.gov (United States)

    Kambara, N; Kitamura, S; Taniguchi, A; Hamao, W; Matsuyama, M

    1995-12-01

    Seventy-seven children for minor surgery of less than 90 minutes in duration were divided into two groups; one group received midazolam syrup and the other received bromazepam suppository. The sedative effect before or after the induction of the anesthetic, the effect on the circulatory system, and the prolongation of the sedative effect after surgery were studied. Regarding the sedative effect before or during the induction of anesthesia, both medications were effective with no significant difference between the two groups. However, the bromazepam suppository had a significantly better sedative effect 1 or 2 hours after the surgery. In children under 4 years of age, the sedative effect during the induction was obtained by administering midazolam syrup before the surgery. It is indicated that midazolam syrup is superior to the bromazepam suppository in children under 4 years of age.

  11. Buccal midazolam spray as an alternative to intranasal route for conscious sedation in pediatric dentistry.

    Science.gov (United States)

    Chopra, Radhika; Mittal, Meenu; Bansal, Kalpana; Chaudhuri, Payal

    2013-01-01

    To evaluate the acceptance of midazolam spray through buccal route as compared to intranasal route and compare the efficacy of the drug through both the routes. 30 patients aged 2-8 years with Grade I or II Frankl's Behaviour Rating Scale were selected who required similar treatment under local anesthesia on two teeth. Midazolam spray was administered randomly through buccal or intranasal routes for the two appointments. Scoring was done for the acceptance of drug and Houpt's score was recorded for the behaviour of patients during the treatment. Acceptance of drug through buccal route was significantly better than the intranasal route (p 0.05). Midazolam spray can be effectively used through the buccal mucosa in children who give poor compliance with the intranasal administration.

  12. Anterograde Amnesia as a Possible Postoperative Complication of Midazolam as an Agent for Intravenous Conscious Sedation

    Science.gov (United States)

    Malamed, Stanley F.; Nikchevich, Donald; Block, James

    1988-01-01

    Anterograde amnesia is often considered to be a beneficial effect of intravenous conscious sedation. The recently introduced benzodiazepine, midazolam, has associated with its administration a significant anterograde amnesic period. In the case presented here, a healthy young female presented for third molar extraction under midazolam conscious sedation and local anesthesia. After uncomplicated removal of the teeth and clinically adequate recovery from sedation, it was noted that the patient had swallowed the postsurgical gauze packs. Efforts at recovery of the gauze packs were futile. Follow-up discussion with the patient revealed a complete lack of recall of all events occurring for up to an hour or more after the administration of intravenous midazolam. The need for written and oral postoperative instructions to both the patient and his/her escort is emphasized. PMID:3166354

  13. A Comparative Study between Intramuscular Midazolam and Oral Clonidine As A Premedication For General Anesthesia

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    Jignasa J Patel

    2015-12-01

    Full Text Available Background: Most anesthesiologists agree on the need for efficient pre-medication. The pattern of desired effects of a pre-medication is however, complex and includes relief of anxiety, sedation and relaxation of the patient. The present study was undertaken to compare the effects of Midazolam and clonidine as premedication. Methodology: A comparative study between midazolam and clonidine as a premedication for general anesthesia was conducted. Patients were divided in two groups: Group I: Inj. Midazolam 0.07 mg/kg i.m. before surgery; Group II Tab.Clonidine 4 and micro;g/kg oral, 2 hours before surgery. Pulse rate, blood pressure, state of excitement, apprehension and sedation were noted at the time of giving premedication. Results: Majority of cases in both the groups were in the age group of 16-30 years (56%. Gender wise distribution shows 40% cases were males and 60% were females. The sedation score, apprehension score and excitement score in both the groups before and after induction was statistically significant. There is no significant difference in dose requirement of pentothal for induction between midazolam and clonidine group. The amnesia score shows that midazolam produces more potent and perfect amnesia as compared to clonidine. Amnesia score in both the groups was statistically significant Conclusion: It was concluded from the present study that midazolam was superior to clonidine in its sedative and anxiolytic effects, had a potent amnesia and does not attenuate hemodynamic response to laryngoscopy and intubation and does not prolong recovery time. [Natl J Med Res 2015; 5(4.000: 312-315

  14. MIDAZOLAM EFFICACY AND SIDE EFFECTS IN GENERALIZED AND PARTIAL REFRACTORY STATUS EPILEPTICUS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    M.R. Salehi Omran

    2009-01-01

    Full Text Available ObjectiveMidazolam is a significant and effective drug for control of a life-threatening condition, generalized and partial refractory convulsive status epilepticus. The goal of this study was evaluation of midazolam efficacy for management of this serious disease and its two side effects, hypotension and respiratory failure.Materials & MethodsOur study was done using a quasi experimental method; 22 children with generalized refractory convulsive status epilepticus and 13 with partial refractory convulsive status epilepticus were enrolled for the study. All patients received 0.2mg/kg/dose as a bolus intravenous midazolam followed by 1-6 mcg/kg/min continuous intravenous midazolam. Following this, termination of seizures as well as hypotension and respiratory failure were evaluated.ResultsMidazolam ceased stop convulsions in 81.81% (18 patients with generalized seizures, and in 76.92% (10 patients with partial seizures, showing no significant difference between these two types of seizures (p=0.52 Hypotension was induced in 18.18% (4 patients with generalized seizures and in 30.70% (4 patients with partial seizures, again difference not significant (p=0.14. There was respiratory failure in 21.73% (5 patients with generalized seizure and in 7.69% (1 patients with partial seizure, difference not significant.(p=0.09ConclusionThere was no significant difference in efficacy and creation of hypotension and respiratory failure after continuous intravenous infusion of midazolam between generalized and partial refractory convulsive status epilepticus.

  15. Assessment of a low dose of IV midazolam used orally for conscious sedation in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    M Mortazavi

    2009-08-01

    Full Text Available Background and the purpose of the study: Midazolam is preferably used in pediatric dentistry for quick onset of action and recovery. The aim of this prospective, observer-blind and placebo-controlled study was to assess the efficacy of a low dose of oral midazolam in modification of  the behavior of young pediatric dental patients. Methods: Forty children aged 3 to 5 years who displayed ratings 1 or 2 on the Frankl Scale and  were healthy by the American Society of Anesthesiologists-I status were randomly divided into two experimental and control groups of 20 each. All children required pulpotomy and restoration of D and E teeth and received either 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup or the syrup alone. Subjects were continuously observed and monitored with pulse oximetry. Houpt's Behavioral Ratings was used to determine the overall behavior, the degree of crying and movement during treatment. Mann-Whitney U test was used for statistical analysis. Results and major conclusion: Patients who received 0.25mg/kg of the prepared oral midazolam significantly behaved better during treatment than the placebo controls (P<0.05. In comparison with the placebo group, reduced movement and crying were observed in the midazolam group (P<0.05. No adverse effects were observed and treatments were completed successfully. A low dose of 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup was found to be effective in conscious sedation of young pediatric dental patients.

  16. The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability.

    Science.gov (United States)

    Win, Ni Ni; Fukayama, Haruhisa; Kohase, Hikaru; Umino, Masahiro

    2005-07-01

    Heart rate (HR) and arterial blood pressure (BP) changes have been reported during conscious sedation with propofol and midazolam. One potential mechanism to explain these changes is that propofol and midazolam affect HR and BP via changes in the cardiac autonomic nervous system. Two specific hypotheses were tested by HR variability analysis: 1) propofol induces predominance of parasympathetic activity, leading to decreased HR and BP, and 2) midazolam induces predominance of sympathetic activity, leading to increased HR and decreased BP. Thirty dental patients were included in a prospective, randomized study. HR, BP, low frequency (LF), high frequency (HF), and entropy were monitored during the awake, sedation, and recovery periods and depth of sedation was assessed using the Observer's Assessment of Alertness/Sedation score. Propofol induced a significant decrease in total power (503 +/- 209 ms(2)/Hz versus 162 +/- 92 ms(2)/Hz) and LF/HF ratio (2.5 +/- 1.2 versus 1.0 +/- 0.4), despite the absence of any change in HR during the sedation period compared with baseline. Midazolam decreased normalized HF (34 +/- 10% versus 10 +/- 4%) but did not significantly change LF/HF ratio (2.3 +/- 1.1 versus 2.2 +/- 1.4) and increased HR in the sedation period. Compared with baseline, propofol was associated with a significant increase in normalized HF in the recovery period (34 +/- 11% versus 44 +/- 12%) and a significant decrease in HR, whereas midazolam was associated with an increase in LF/HF ratio (2.3 +/- 1.1 versus 3.7 +/- 1.8) with no change in HR. These results indicated a dominant parasympathetic effect of propofol and a dominant sympathetic effect of midazolam in both periods. These results should be considered during conscious sedation, especially in patients at risk of cardiovascular complications.

  17. Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

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    Hany A Mowafi

    2012-01-01

    Full Text Available Context: Objective assessment of sedation depth is a valuable target. Spectral entropy is an anesthetic depth monitor based on the analysis of the electroencephalogram signal. Aims: To evaluate the performance of spectral entropy as an objective measure of sedation state in midazolam-premedicated patients and to correlate it with a clinically assessed sedation score. Settings and Design: This prospective double-blind placebo-controlled study was performed in King Fahd Hospital of the university. Methods: Eighty adult ASA I-II patients were randomly assigned into 4 groups. Patients were premedicated using 0.02, 0.04, or 0.06 mg/kg midazolam or saline intramuscularly. The effect of these doses on the Observer′s Assessment of Alertness and Sedation (OAA/S scale, hemodynamic variables, response entropy (RE, and state entropy (SE, was evaluated at 10, 20, and 30 min after premedication. Statistical analysis: Spearman Rank-order correlation analysis to examine the relation between OAA/S and entropy. The ability of spectral entropy to predict the depth of sedation was evaluated using Smith prediction probability. Results: Midazolam doses ≥0.04 mg/kg produced significant decreases in RE, SE, and OAA/S scores. There was a strong correlation between midazolam dose and OAA/S scale, RE, and SE since Spearman Rank R values were 0.792, 0.822, and 0.745, respectively (P<0.001. In addition, RE and SE were strong predictors of OAA/S level during midazolam sedation with no significant difference in prediction between the 2 entropy components. Conclusions: Spectral entropy is a reliable measure for the sedative premedication. It may be used to objectively assess the adequacy of midazolam premedication and to determine the dose requirement.

  18. Midazolam-ketamine dual therapy stops cholinergic status epilepticus and reduces Morris water maze deficits.

    Science.gov (United States)

    Niquet, Jerome; Baldwin, Roger; Norman, Keith; Suchomelova, Lucie; Lumley, Lucille; Wasterlain, Claude G

    2016-09-01

    Pharmacoresistance remains an unsolved therapeutic challenge in status epilepticus (SE) and in cholinergic SE induced by nerve agent intoxication. SE triggers a rapid internalization of synaptic γ-aminobutyric acid A (GABAA ) receptors and externalization of N-methyl-d-aspartate (NMDA) receptors that may explain the loss of potency of standard antiepileptic drugs (AEDs). We hypothesized that a drug combination aimed at correcting the consequences of receptor trafficking would reduce SE severity and its long-term consequences. A severe model of SE was induced in adult Sprague-Dawley rats with a high dose of lithium and pilocarpine. The GABAA receptor agonist midazolam, the NMDA receptor antagonist ketamine, and/or the AED valproate were injected 40 min after SE onset in combination or as monotherapy. Measures of SE severity were the primary outcome. Secondary outcomes were acute neuronal injury, spontaneous recurrent seizures (SRS), and Morris water maze (MWM) deficits. Midazolam-ketamine dual therapy was more efficient than double-dose midazolam or ketamine monotherapy or than valproate-midazolam or valproate-ketamine dual therapy in reducing several parameters of SE severity, suggesting a synergistic mechanism. In addition, midazolam-ketamine dual therapy reduced SE-induced acute neuronal injury, epileptogenesis, and MWM deficits. This study showed that a treatment aimed at correcting maladaptive GABAA receptor and NMDA receptor trafficking can stop SE and reduce its long-term consequences. Early midazolam-ketamine dual therapy may be superior to monotherapy in the treatment of benzodiazepine-refractory SE. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  19. Midazolam-Droperidol, Droperidol, or Olanzapine for Acute Agitation: A Randomized Clinical Trial.

    Science.gov (United States)

    Taylor, David McD; Yap, Celene Y L; Knott, Jonathan C; Taylor, Simone E; Phillips, Georgina A; Karro, Jonathan; Chan, Esther W; Kong, David C M; Castle, David J

    2017-03-01

    We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg, or olanzapine 5 mg. The primary outcome was the proportion of patients adequately sedated at 10 minutes. Three hundred forty-nine patients were randomized to the 3 groups. Baseline characteristics were similar across the groups. Ten minutes after the first dose, significantly more patients in the midazolam-droperidol group were adequately sedated compared with the droperidol and olanzapine groups: differences in proportions 25.0% (95% confidence interval [CI] 12.0% to 38.1%) and 25.4% (95% CI 12.7% to 38.3%), respectively. For times to sedation, the differences in medians between the midazolam-droperidol group and the droperidol and olanzapine groups were 6 (95% CI 3 to 8) and 6 (95% CI 3 to 7) minutes, respectively. Patients in the midazolam-droperidol group required fewer additional doses or alternative drugs to achieve adequate sedation. The 3 groups' adverse event rates and lengths of stay did not differ. Midazolam-droperidol combination therapy is superior, in the doses studied, to either droperidol or olanzapine monotherapy for intravenous sedation of the acutely agitated ED patient. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  20. Effect of Low-Furanocoumarin Hybrid Grapefruit Juice Consumption on Midazolam Pharmacokinetics.

    Science.gov (United States)

    Kawaguchi-Suzuki, Marina; Nasiri-Kenari, Negar; Shuster, Jonathan; Gmitter, Fred G; Cancalon, Paul; de Oliveria, Felipe; Kight, Jennifer; Handberg, Eileen M; Pepine, Carl J; Frye, Reginald F; Cooper-DeHoff, Rhonda M

    2017-03-01

    The objectives of this study were to investigate the effect of grapefruit juice low in furanocoumarins on CYP3A activity and to summarize previous findings of enzyme inhibition measured by the metabolism of midazolam after intake of grapefruit juice. Twelve healthy volunteers participated in a prospective, randomized, double-blinded, 3-way crossover clinical study to determine the effect of regular grapefruit juice (RGJ) and a novel, low-furanocoumarin hybrid grapefruit juice (HGJ) on the metabolism of oral midazolam, used as a probe for in vivo CYP3A activity, compared with water as a control. The RGJ was 100% hand-squeezed "Hudson" grapefruit juice, and the HGJ contained low amounts of furanocoumarin constituents. The point estimates (90% confidence intervals) for the RGJ/water midazolam AUC geometric mean ratio was 122% (107-140). The point estimate for the HGJ/water midazolam AUC ratio was within the 80% to 125% bioequivalence range, indicating an absence of interaction. This finding also prompted a systematic review of available evidence on the pharmacokinetic alteration of midazolam by grapefruit juice. Although most studies demonstrated alteration in midazolam pharmacokinetics supporting inhibition of CYP3A activity as a likely mechanism, the cohorts included in these studies and the extent of the pharmacokinetic interaction varied widely. The current study indicated grapefruit juice-drug interaction varies substantially based on patient characteristics and/or grapefruit juice product-related factors, including the amount of furanocoumarin constituents present in the juice. © 2016, The American College of Clinical Pharmacology.

  1. Premedicación con midazolam vía oral en pacientes pediátricos, Hospitales Vicente Corral Moscoso, José Carrasco Arteaga Cuenca 1996 -1997

    OpenAIRE

    Carrera Reyes, Rosa Eulalia; Peña C., Jorge

    1998-01-01

    Objetivos: Disminuir la ansiedad y el estrés que presentan los niños que van a ser sometidos a intervenciones quirúrgicas, antes de ingresar a la sala de operaciones. Materiales y Métodos: Se incluyeron 128 niños de ambos sexos, ASA I-II entre 1 y 12 años, sometidos a cirugía en los hospitales José Carrasco de IESS y Vicente Corral del MSP, de la ciudad de Cuenca, desde noviembre de 1996 hasta noviembre de 1997. Se formaron dos grupos aleatorizados: a] grupo CON MIDAZOLAM [Mz], 64 niños a los...

  2. A comparison of midazolam and clonidine as an oral premedication in pediatric patients

    OpenAIRE

    Sequeira Trevor; Madhusudan Upadya; Chandni Sinha; Manpreet Kaur

    2012-01-01

    Background: To compare oral midazolam (0.5 mg/kg) versus oral clonidine (4 μg/kg) as a premedication in pediatric patients aged between 2-12 years with regard to sedation and anxiolysis. Methods: Sixty pediatric patients belonging to the American Society of Anesthesiologists class I and II between the age group of 2-12 years scheduled for elective surgery were randomly allocated to receive either oral midazolam (group I) 30 min before induction or oral clonidine (group II) 90 min before induc...

  3. Assessment of a low dose of IV midazolam used orally for conscious sedation in pediatric dentistry

    OpenAIRE

    M. Mortazavi; Pourhashemi SJ; Khosravi, M. B.; S Ashtari; F. Ghaderi

    2009-01-01

    Background and the purpose of the study: Midazolam is preferably used in pediatric dentistry for quick onset of action and recovery. The aim of this prospective, observer-blind and placebo-controlled study was to assess the efficacy of a low dose of oral midazolam in modification of  the behavior of young pediatric dental patients. Methods: Forty children aged 3 to 5 years who displayed ratings 1 or 2 on the Frankl Scale and  were healthy by the American Society of Anesthesi...

  4. A comparison of effects of Diazepam and Midazolam on Ketamine induced postoperative Hallucination

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    fereidon Sabzi

    2006-11-01

    Results: Incidence of hallucination in the first group is 36% and in the other group is 8%. Chi- Square test demonstrates a significant statistical difference between the two groups (p.v=0.017 and K.sq=5.71. Conclusions: Analysis of data demostrated that midazolam is more effective than diazpam for prevention of ketamine induced postoperative hallucination. According to the above although postoperative hallucination induced by ketamine has no effective treatment but can be prevented effectively using benzodiazepines especially midazolam.

  5. [Analgosedation with fentanyl/midazolam after correction of congenital heart defects].

    Science.gov (United States)

    Michel-Behnke, I; Rothes, A; Hund, F; Huth, R; Wippermann, C F; Schmidt, F X; Oelert, H; Schranz, D

    1995-01-01

    There is no standard therapy in the management of postoperative pain control following corrective cardiac surgery of congenital heart disease. Assessment in the preverbal age is difficult. In a randomized study we compared a combined treatment of fentanyl and midazolam, given as continuous infusion versus single dose application. A pain assessment score was used to measure the effectiveness of analgosedation in addition to recording nurseries observations. Fentanyl and midazolam are an appropriate combination for postoperative pain treatment. Continuous application is considered to be more effective concerning basic anxiety, cumulative dosage and to avoid volume overload in infants and young children, following cardiac surgery; overdosage was not observed.

  6. The reversal of midazolam sedation with the benzodiazepine antagonist flumazenil (Anexate).

    Science.gov (United States)

    Merry, A F; Clapham, G J; Walker, J S

    1988-09-14

    Flumazenil (Anexate) was used to reverse midazolam sedation in a series of 108 patients undergoing minor diagnostic or therapeutic procedures. At a mode dose of 0.5 mg IV, flumazenil was shown to rapidly and predictably reverse the sedation produced by a mode dose of 5 mg midazolam. Amnesia for the procedure was excellent in all but three cases, and side effects were infrequent and minor. In the endoscopy clinic, the use of flumazenil was perceived by clinicians to significantly improve the speed and quality of recovery.

  7. A randomized, blinded comparison of chloral hydrate and midazolam sedation in children undergoing echocardiography.

    Science.gov (United States)

    Wheeler, D S; Jensen, R A; Poss, W B

    2001-07-01

    The objective of this prospective, randomized, and blinded study was to compare the use of chloral hydrate versus oral midazolam sedation in children undergoing echocardiography. No adverse effects (nausea, vomiting, paradoxical agitation, or significant deviations from baseline vital signs) were noted with either medication. No differences were noted in onset of sedation between the 2 groups, however, the time to complete recovery was significantly shorter with midazolam than with chloral hydrate. The children in the chloral hydrate group had a significantly deeper level of sedation and were more likely to receive a more nearly comprehensive echocardiographic evalation.

  8. Comparison of the sedative effects of midazolam and dexmedetomidine during regional anaesthesia

    OpenAIRE

    Mehmet Korkmaz; Alp Gurbet; Şükran Şahin; Özden Özkurt Pürcü

    2011-01-01

    The aim of this study was to compare the efficacy of dexmedetomidine versus midazolam for sedation under spinal anesthesia for arthroscopic knee surgery.Materials and methods: Fifty adult patients, 18 to 65 years, were randomized into two groups: Group M received 0.04 mg/kg iv bolus midazolam followed by administration of 0.5 mg boluses to provide Ramsay sedation Scale (RSS) 3-4. Group D received dexmedetomidine loading dose of 1 μg/kg/h over 10 minutes and the maintenance dose of 0.2-0.7 μg/...

  9. Intestinal first pass metabolism of midazolam in liver cirrhosis --effect of grapefruit juice

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Pedersen, Natalie; Larsen, Niels-Erik

    2002-01-01

    Grapefruit juice inhibits CYP3A4 in the intestinal wall leading to a reduced intestinal first pass metabolism and thereby an increased oral bioavailability of certain drugs. For example, it has been shown that the oral bioavailability of midazolam, a CYP3A4 substrate, increased by 52% in healthy...... subjects after ingestion of grapefruit juice. However, this interaction has not been studied in patients with impaired liver function. Accordingly, the effect of grapefruit juice on the AUC of midazolam and the metabolite alpha-hydroxymidazolam was studied in patients with cirrhosis of the liver....

  10. Midazolam inhibits neophobia-induced Fos expression in the rat hippocampus.

    Science.gov (United States)

    Wisłowska-Stanek, A; Zienowicz, M; Lehner, M; Taracha, E; Bidziński, A; Maciejak, P; Skórzewska, A; Szyndler, J; Płaźnik, A

    2006-01-01

    The effect of midazolam on expression of c-Fos protein was examined in the rat hippocampus, following the open field test of neophobia. It was found that pretreatment of rats with midazolam, at the dose of 0.5 mg/kg, enhanced rat exploratory behavior, and inhibited neophobia related stimulation of c-Fos in the CA-1 and CA-3 areas of the hippocampus. The presented results provide new immunocytochemical data on the involvement of hippocampus in emotional processes related to neophobia, and indicate a possible site of action of benzodiazepines.

  11. Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

    Institute of Scientific and Technical Information of China (English)

    Ludwig T Heuss; Shajan Peter Sugandha; Christoph Beglinger

    2012-01-01

    AIM:To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol.METHODS:Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme.All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen.Oxygen saturation (SpO2) was measured by pulse oximetry (POX),and capnography (PcCO2) was continuously measured using a combined dedicated sensor at the ear lobe.Instances of apnea resulting in measures such as stimulation of the patient,a chin lift,a mask maneuver,or withholding of sedation were recorded.PcCO2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points:baseline,maximal rise,termination of the procedure and 5 min after termination of the procedure.The number of patients in both study groups who regained baseline PcCO2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS:A total of 97 patients entered this study.The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems.Therefore,83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n =42) or midazolam (n =41) for sedation.Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups,respectively].A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms.The mean SpO2 at baseline (%) was 99± 1 for the midazolam group and 99 ± 1 for the propofol group.No cases of hypoxemia (SpO2 < 85%) or apnea were

  12. Randomized perturbed posturography: methodology and effects of midazolam sedation.

    Science.gov (United States)

    Ledin, T; Gupta, A; Larsen, L E; Odkvist, L M

    1993-05-01

    To study quiescent stance without applying external disturbances is not a theoretically appealing way to unveil the dynamic properties of human equilibrium. Methods to disturb equilibrium range from standing on foam surface, attaching vibrators to the calves to interfere with somatosensation, and exposure to body-position tracking environments, as in dynamic posturography (EquiTest). The EquiTest apparatus was modified by a menu-driven software to allow arbitrary movements of the support surface and visual surround, and force data were recorded for subsequent analysis. The support surface was randomly moved in the antero-posterior direction. First equilibrium was studied on the stable support surface, then low (RMS 1.3 cm) and high (RMS 2.6 cm) amplitude movements were used. Vision was either present or absent at all test amplitudes. Equilibrium was evaluated by the confidence (61%) ellipse sway area and average sway velocity during 45 s. Eleven healthy subjects aged 23-36 years (mean 29) were sedated with a short acting sedative, midazolam 0.1 mg/kg. Randomized perturbed posturography was conducted at baseline, and at about 60, 120 and 180 min after injection. Psychomotor tests were conducted at baseline, and at 30, 90, 150 and 210 min. Large interindividual variations were found. One subject could not be tested at all at 60 min due to sleepiness, whereas some subjects felt nearly full awake at 30 min. Sway areas were larger at 60 min, but not subsequently. At 60 min, sway velocities with open eyes were higher, just as when vision was absent and low amplitude movements were used. Later no effects could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. The Influence of Single-Dose and Short-Term Administration of Quercetin on the Pharmacokinetics of Midazolam in Humans.

    Science.gov (United States)

    Nguyen, Mai Anh; Staubach, Petra; Wolffram, Siegfried; Langguth, Peter

    2015-09-01

    Quercetin is a plant flavonol that is available from both daily diet and nutraceuticals. To investigate the effect of acute and short-term intake of high-dose quercetin on CYP3A-mediated metabolism, 10 healthy volunteers received 7.5 mg oral midazolam without, with a single dose of 1500 mg quercetin and after 1-week supplementation with 1500 mg quercetin daily. A substudy was performed in three subjects to explore the impact of repeated quercetin intake on intravenously administered midazolam. Coadministration with a single dose of quercetin did not significantly alter the pharmacokinetics of midazolam and its 1'-hydroxymetabolite, but following short-term quercetin intake, there was a trend to reduced midazolam exposure (geometric mean ratio of test-control area under the plasma concentration-time curve (AUC0-∞ ): 0.82; 90% confidence interval: 0.61-1.10) and midazolam-metabolite AUC0-∞ ratios were decreased by 9.7%-47.6% from control in seven subjects. The tendency was opposite when midazolam was given intravenously. We conclude that a single dose of quercetin would not provoke any toxic adverse events when coadministered with midazolam, whereas repeated quercetin intake can reduce systemic exposure to the orally given drug by increasing its CYP3A-catalyzed metabolism. As the effect deviated after intravenous drug administration, different mechanisms of interaction may be involved at the intestinal site compared with the liver.

  14. Effect of multiple intravenous doses of lanicemine (AZD6765) on the pharmacokinetics of midazolam in healthy subjects.

    Science.gov (United States)

    Bui, Khanh H; Zhou, Diansong; Agbo, Felix; Guo, Jian

    2015-09-01

    The objectives of the present study were to evaluate safety and tolerability as well as the effects of multiple doses of lanicemine on the pharmacokinetics of a CYP3A substrate, midazolam. A total of 46 healthy volunteers were enrolled in the open-label, fixed-sequence, nonrandomized study. All volunteers received an oral dose of 5 mg of midazolam alone or after 6 days of 150 mg daily intravenous infusion of lanicemine. Lanicemine reached a plasma Cmax of 1.51 μg/mL after 150 mg daily dosing to steady state. The geometric mean CL, Vss, and t1/2 of lanicemine were 8.1 L/h, 122.0 L, and 10.4 hours, respectively. The geometric least-squares mean ratios and 90% confidence intervals for midazolam AUC0- ∞ , and Cmax were within the 80% to 125% limits when lanicemine plus midazolam treatment was compared with midazolam alone, demonstrating that daily dosing with 150 mg of lanicemine for 6 days had no effect on CYP3A activity. Comprehensive physiologically based pharmacokinetic modeling using in vitro and in silico findings also indicated lanicemine would have little impact on the pharmacokinetics of CYP3A substrate, such as midazolam. In addition, lanicemine and midazolam administered alone or in combination were generally safe and well tolerated.

  15. Intra-operative Patient-Controlled Sedation (PCS:Propofol versus Midazolam Supplementation During Epidural Analgesia (Clinical and Hormonal Study

    Directory of Open Access Journals (Sweden)

    Hassan S Al-khayat

    2008-01-01

    Full Text Available This study was done on sixty adult males scheduled to have an epidural analgesia for elective inguinal hernia repair. The study was designed to compare propofol and midazolam with regard to their suitability for the patient-controlled sedation (PCS technique during epidural analgesia. Patients were divided into three equal groups and premedicated with 0.2mg.kg -1 oral midazolam. Group I (G1 served as control. Using PCS technique, the pump was programmed to deliver on demand a bolus dose of 0.5 mg.kg- 1 of propofol in Group II (G2 or 0.1mg.kg -1 midazolam in Group III(G3. Patient′s sedation status was assessed by sedation score, comfort scale and by psychometric testing. The total delivered dose of each tested drug was calculated. Serum concentrations of propfol and midazolam, plasma cortisol and free fatty acids were measured. Propofol and midazolam PCS technique produced excellent and easily controllable sedation. The dose needed to produce steady state sedation was 2.8±1.42 and 0.11±0.6 mg.kg -1 .h- 1 for propofol and midazolam respectively. Propofol was more suitable than midazolam for PCS because of its rapid onset, favorable recovery profile and low side effects. PCS proved to be a stress-free and acceptable technique.

  16. Prednisone has no effect on the pharmacokinetics of CYP3A4 metabolized drugs - midazolam and odanacatib.

    Science.gov (United States)

    Marcantonio, Eugene E; Ballard, Jeanine; Gibson, Christopher R; Kassahun, Kelem; Palamanda, Jairam; Tang, Cuyue; Evers, Raymond; Liu, Chengcheng; Zajic, Stefan; Mahon, Chantal; Mostoller, Kate; Hreniuk, David; Mehta, Anish; Morris, Denise; Wagner, John A; Stoch, S Aubrey

    2014-11-01

    We evaluated the effect of prednisone on midazolam and odanacatib pharmacokinetics. In this open-label, 2-period crossover study in healthy male subjects, midazolam 2 mg was administered (Day -1) followed by odanacatib 50 mg (Day 1) during Part 1. In Period 2, prednisone 10 mg once daily (qd) was administered on Days 1-28; odanacatib was co-administered on Day 14 and midazolam 2 mg was co-administered on Days 1 and 28. Subjects were administered midazolam 2 mg on Days 42 and 56. Safety and tolerability were assessed throughout the study. A physiologically-based pharmacokinetic (PBPK) model was also built. There were 15 subjects enrolled; mean age was 31 years. The odanacatib AUC(0- ∞) GMR (90% CI) [odanacatib + prednisone (Day 14, Period 2)/odanacatib alone (Day 1, Period 1] was 1.06 (0.96, 1.17). AUC(0-∞) GMR (90%CI) [midazolam + prednisone (Day 28, Period 2)/midazolam alone (Day -1, Period 1] was 1.08 (0.93,1.26). There were no serious AEs or AEs leading to discontinuation. PBPK modeling showed that prednisone does not cause significant effects on the exposure of sensitive CYP3A4 substrates in vivo at therapeutic doses. Co-administration of prednisone 10 mg qd had no effect on pharmacokinetics of either odanacatib 10 mg or midazolam 2 mg.

  17. A Comparison of Midazolam, Lorazepam, and Diazepam for the Treatment of Status Epilepticus in Children: A Network Meta-analysis.

    Science.gov (United States)

    Zhao, Zi-Yu; Wang, Hong-Ying; Wen, Bin; Yang, Zhi-Bo; Feng, Kang; Fan, Jing-Chun

    2016-08-01

    Midazolam, lorazepam, and diazepam were recommended as emergent initial therapy for status epilepticus. However, there are no current studies to confirm the best agent for pediatric status epilepticus. We compared the efficacy of midazolam, lorazepam, and diazepam in treating pediatric status epilepticus using a network meta-analysis method. In total, 16 randomized controlled trials containing 1821 patients were included. Nonintravenous midazolam, intravenous lorazepam, and intravenous diazepam were more successful in achieving seizure cessation when compared with nonintravenous diazepam (odds ratio = 2.23, 95% credibility interval: 1.62, 3.10; odds ratio = 2.71, 95% credibility interval: 1.25, 5.89; odds ratio = 2.65, 95% credibility interval: 1.12, 6.29; respectively). Among lorazepam, midazolam, and diazepam, midazolam had the highest probability (surface under the cumulative ranking area [SUCRA] = 0.792) of achieving seizure cessation, and lorazepam had the largest probability (surface under the cumulative ranking area = 0.4346) of being the best treatment in reduction of respiratory depression. In conclusion, nonintravenous midazolam and intravenous lorazepam were superior to intravenous or nonintravenous diazepam, and intravenous lorazepam was at least as effective as nonintravenous midazolam in treating pediatric status epilepticus.

  18. A comparison of the effects of midazolam/fentanyl and midazolam/tramadol for conscious intravenous sedation during third molar extraction.

    Science.gov (United States)

    Göktay, Ozgen; Satilmiş, Tülin; Garip, Hasan; Gönül, Onur; Göker, Kamil

    2011-06-01

    This study evaluated the effects of fentanyl and tramadol, used in combination, as sedation for third molar surgical extraction. This prospective, randomized, double-blind, placebo-controlled study included 60 patients undergoing extraction of a horizontal third molar with an Amsterdam Preoperative Anxiety and Information Scale score above 10 points. All of the patients were first given a 0.03-mg/kg bolus of midazolam, and then they were randomized into 3 groups: group A, midazolam only; group B, midazolam and 1-μg/kg fentanyl; and group C, midazolam and 1-mg/kg tramadol. The vital signs were recorded. Patients were assessed for postoperative pain and adverse effects, and patient and surgeon satisfaction was assessed. No differences were found in the heart rate among groups (P > .05). The mean blood pressure was also similar until the 40th minute, after which the mean blood pressure in the patients in group A was lower than that in the other 2 groups (P scale scores of the patients in group C were lower than those in the other 2 groups in the first postoperative hour (P < .05). The time at which the first rescue analgesic was taken in groups A, B, and C was 3, 3.5, and 5 hours postoperatively, respectively, and was significantly later in group C (P < .01). No difference was found in patient/surgeon satisfaction among the groups. Tramadol has a better analgesic effect in third molar surgery than fentanyl and placebo. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Midazolam induces apoptosis in MA-10 mouse Leydig tumor cells through caspase activation and the involvement of MAPK signaling pathway

    Directory of Open Access Journals (Sweden)

    So EC

    2014-02-01

    Full Text Available Edmund Cheung So,1,2 Yu-Xuan Lin,3 Chi Hao Tseng,1 Bo-Syong Pan,3 Ka-Shun Cheng,2 Kar-Lok Wong,2 Lyh-Jyh Hao,4 Yang-Kao Wang,5 Bu-Miin Huang2 1Department of Anesthesia, Tainan Municipal An Nan Hospital, China Medical University, Tainan, Taiwan; 2Department of Anesthesia, China Medical University, Taichung, Taiwan; 3Department of Cell Biology and Anatomy, National Cheng Kung University, Tainan, Taiwan; 4Department of Internal Medicine, Division of Endocrinology and Metabolism, Kaohsiung Veteran General Hospital Tainan Branch Tainan, Taiwan; 5Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan Purpose: The present study aims to investigate how midazolam, a sedative drug for clinical use with cytotoxicity on neuronal and peripheral tissues, induced apoptosis in MA-10 mouse Leydig tumor cells. Methods: The apoptotic effect and underlying mechanism of midazolam to MA-10 cells were investigated by flow cytometry assay and Western blotting methods. Results: Data showed that midazolam induced the accumulation of the MA-10 cell population in the sub-G1 phase and a reduction in the G2/M phase in a time- and dose-dependent manner, suggesting an apoptotic phenomenon. Midazolam could also induce the activation of caspase-8, -9, and -3 and poly (ADP-ribose polymerase proteins. There were no changes in the levels of Bax and cytochrome-c, whereas Bid was significantly decreased after midazolam treatment. Moreover, midazolam decreased both pAkt and Akt expression. In addition, midazolam stimulated the phosphorylation of p38 and c-Jun NH2-terminal kinase but not extracellular signal-regulated kinase. Conclusion: Midazolam could induce MA-10 cell apoptosis through the activation of caspase cascade, the inhibition of pAkt pathway, and the induction of p38 and c-Jun NH2-terminal kinase pathways. Keywords: midazolam, apoptosis, MA-10 cell, caspase, Akt, MAPKs

  20. Midazolam anesthesia protects neuronal cells from oxidative stress-induced death via activation of the JNK-ERK pathway.

    Science.gov (United States)

    Liu, Jing-Yu; Guo, Feng; Wu, Hong-Ling; Wang, Ying; Liu, Jin-Shan

    2017-01-01

    Midazolam is an anesthetic agent commonly used during clinical and surgical procedures, which has been shown to exert ROS‑suppressing and apoptosis‑modulating pharmacological activities in various cellular systems. However, the effects of midazolam on oxidative stress in neuronal cells require elucidation. The present study investigated the effects of midazolam on buthionine sulfoximine (BSO)‑ and hydrogen peroxide (H2O2)‑induced oxidative stress in primary cortical neuronal cells. In addition, the effects of midazolam on middle cerebral artery occlusion (MCAO) in mice and on ethanol‑induced neuroapoptosis in the brains of neonatal mice were determined. Subsequently, cell viability was detected using the MTT assay; intracellular reactive oxygen species (ROS) generation was determined using the 2',7'‑dichlorodihydrofluorescein diacetate method with confocal microscopy; terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was conducted to detect apoptotic cells; immunohistochemistry was performed to detect activated caspase‑3; neuronal deficit and infarct volume analyses were conducted; and quantitative polymerase chain reaction and western blotting were performed to detect the expression levels of genes and proteins associated with apoptosis and cell survival pathways. The results demonstrated that BSO (10 mM) and H2O2 (1 mM) suppressed proliferation of cortical neuronal cells by inducing apoptosis. These effects were suppressed following treatment with midazolam in a dose‑dependent manner. In addition, BSO and H2O2 induced ROS generation in neuronal cells; however, this was effectively suppressed by midazolam (100 µM). Beneficial synergistic effects were detected when midazolam was used in combination with the known antioxidant trolox. BSO and H2O2 also suppressed the protein expression levels of c‑Jun N‑terminal kinases (JNK), phosphorylated (p)JNK, extracellular signal‑regulated kinases (ERK)1/2, pERK1/2, AKT and

  1. Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Heloisa Sousa GOMES

    2015-01-01

    Full Text Available Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS and placebo (PS. An observer assessed the children’s behaviour (videos using the Ohio State University Behavioral Rating Scale (OSUBRS. The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level. Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004, but did not vary during the appointment within sedation (p = 0.319 or placebo (p = 0.080 groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

  2. PK-PD modelling of the interaction of propofol and midazolam : implementation and future perspectives

    NARCIS (Netherlands)

    Lichtenbelt, Bart Jan

    2013-01-01

    This thesis describes the day to day interaction between propofol and midazolam as encountered in every day practice. The direct interaction of premedication given to patients before surgery has profound implications. The propofol induction dose can be decreased with respect to the target BIS.

  3. Conscious sedation-An artist′s science! An Indian experience with midazolam

    Directory of Open Access Journals (Sweden)

    Shashikiran N

    2006-03-01

    Full Text Available The present study was undertaken to evaluate Midazolam as a Paediatric conscious sedative agent for a routine Indian dental setup and to compare its efficacy and safety when administered by intranasal and intramuscular routes, at a dosage of 0.2 mg/kg body weight. The present study was accomplished in two phases: Phase 1: Preliminary dose finding pilot study on 10 children. Phase 2: Single dose, randomized parallel clinical trial on 40 children between the ages of 2 and 5 years. These children were randomly assigned to two groups consisting of 20 subjects each. Group M, received Midazolam intramuscularly, while Group N received Midazolam intranasally. Both the intranasal and intramuscular groups showed highly significant decrease in crying levels, motor movements and sensory perception levels, post-sedation ( P < 0.001. Though both the routes almost matched each other in their efficacy and safety profiles, the intranasal route showed a significantly faster pharmacodynamic profile in terms of faster onset, peak and recovery times ( P < 0.001. Midazolam could be safely and successfully employed by intranasal and intramuscular routes for Paediatric conscious sedation in a routine dental setup with basic facilities at a dosage of 0.2 mg/ kg body weight. Whenever the clinical situation warrants a faster action, peak and recovery, the intranasal route should be the obvious choice.

  4. Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Hyuk Lee; Jeong Hwan Kim

    2009-01-01

    AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A ( n = 40) received a split dose of midazolam in combination with meperidine. Group B ( n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia ( P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B ( P = 0.043). Group B recovered from sedation slightly sooner than group A ( P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination ( P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B ( P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

  5. PK-PD modelling of the interaction of propofol and midazolam : implementation and future perspectives

    NARCIS (Netherlands)

    Lichtenbelt, Bart Jan

    2013-01-01

    This thesis describes the day to day interaction between propofol and midazolam as encountered in every day practice. The direct interaction of premedication given to patients before surgery has profound implications. The propofol induction dose can be decreased with respect to the target BIS. Besid

  6. Correlation between midazolam and lignocaine pharmacokinetics and MEGX formation in healthy volunteers

    NARCIS (Netherlands)

    Swart, Eleonora L; van der Hoven, Ben; Groeneveld, A B Johan; Touw, Daniel J; Danhof, Meindert

    2002-01-01

    AIMS: The objectives of the present investigation were: (a) to determine the correlation between lignocaine and midazolam pharmacokinetics following intravenous administration in healthy volunteers, (b) to determine the effects of treatment with an inhibitor of CYP3A4 (erythromycin) on this correlat

  7. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam.

    Science.gov (United States)

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. A total of sixty adult patients of age group 18-65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  8. Inhibition of cancer cell proliferation by midazolam by targeting transient receptor potential melastatin 7.

    Science.gov (United States)

    Dou, Yunling; Li, Yuan; Chen, Jingkao; Wu, Sihan; Xiao, Xiao; Xie, Shanshan; Tang, Lipeng; Yan, Min; Wang, Youqiong; Lin, Jun; Zhu, Wenbo; Yan, Guangmei

    2013-03-01

    Transient receptor potential melastatin 7 (TRPM7), a Ca(2+)-permeable channel, has been demonstrated to be present in cancer cells and involved in their growth and proliferation. The present study used midazolam, a benzodiazepine class anesthesic, to pharmacologically intervene in the expression of TRPM7 and to inhibit cancer cell proliferation. Midazolam significantly inhibited the growth and proliferation of FaDu human hypopharyngeal squamous cell carcinoma cells, concurring with the induction of G(0)/G(1) cell cycle arrest and blockage of Rb activation. Central-type and peripheral-type benzodiazepine receptor antagonists did not abrogate proliferation inhibition by midazolam, while the specific TRPM7 agonist bradykinin reversed this effect. In addition, other benzodiazepines, diazepam and clonazepam also exhibited anti-proliferative activities. The inhibitory activity on cancer cell growth and proliferation, combined with the TRPM-dependent mechanism, reveals the anticancer potential of midazolam as a TRPM7 inhibitor and supports the suggestion that TRPM7 is a valuable target for pharmaceutical intervention.

  9. Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Damle S

    2008-09-01

    Full Text Available The safe and effective treatment of uncooperative or combative preschool children with extensive dental needs is one of pediatric dentist′s ongoing challenges. The traditional methods of behavior management are no longer acceptable to parents as they are not ready to spare more time for dental treatment of their children. Keeping this in mind, the present study was designed and carried out to evaluate the sedative effects of oral ketamine and oral midazolam prior to general anesthesia. Twenty uncooperative children in the age-group of 2-6 years were selected after thorough medical examination and investigations. Informed consent was obtained from the parent. This was a randomized double-blind study. An anesthesiologist administered either 0.5 mg/kg midazolam or 5 mg/kg ketamine orally. The heart rate, respiratory rate, and oxygen saturation were recorded at regular intervals. The sedation and anxiolysis scores were also recorded. The parents were asked to answer a questionnaire at the follow-up session the next day on the surgical experience of the parent and the child and side effects experienced, if any. When the data was subjected to statistical analysis, it was observed that both drugs resulted in adequate sedation at the end of 30 min, with oral midazolam providing significantly better anxiolysis. The heart rate and respiratory rate were marginally higher with oral ketamine. The questionnaire revealed a better response with oral midazolam; side effects were more prominent with oral ketamine.

  10. Intestinal first pass metabolism of midazolam in liver cirrhosis --effect of grapefruit juice

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Pedersen, Natalie; Larsen, Niels-Erik

    2002-01-01

    Grapefruit juice inhibits CYP3A4 in the intestinal wall leading to a reduced intestinal first pass metabolism and thereby an increased oral bioavailability of certain drugs. For example, it has been shown that the oral bioavailability of midazolam, a CYP3A4 substrate, increased by 52% in healthy...

  11. [Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial].

    Science.gov (United States)

    Linares Segovia, B; García Cuevas, M A; Ramírez Casillas, I L; Guerrero Romero, J F; Botello Buenrostro, I; Monroy Torres, R; Ramírez Gómez, X S

    2014-10-01

    Dexmedetomidine is a pharmacological option for sedation in children. In this study, the efficacy of intranasal dexmedetomidine to reduce preoperative anxiety in pediatric patients is compared with that of oral midazolam. A prospective, randomized, double-blind, controlled trial was conducted on children 2-12 years of age, randomly assigned to one of the following two groups: group A received premedication with oral midazolam and intranasal placebo, group B received intranasal dexmedetomidine and oral placebo. Anxiety was assessed with the modified Yale scale, and a risk analysis and number needed to treat was performed. A total of 108 patients were included, 52 (48.1%) treated with dexmedetomidine, and 56 (51.9%) with midazolam. Anxiety was less frequent in the dexmedetomidine group at 60minutes (P=.001), induction (p=.04), and recovery (P=.0001). Risk analysis showed that dexmedetomidine reduced the risk of anxiety by 28% (RAR=0.28, 95% CI; 0.12 to 0.43) and to prevent one case of anxiety, four patients need to be treated with intranasal dexmedetomidine (NNT=4, 95% CI: 3-9).Changes in heart rate, mean arterial pressure, and oxygen saturation, were statistically significant in the dexmedetomidine group, with no clinical consequences. There were no cases of bradycardia, hypotension or oxygen desaturation. Intranasal dexmedetomidine premedication is more effective than oral midazolam to reduce preoperative anxiety in pediatric patients. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  12. Ketamine and midazolam sedation for pediatric gastroinntestinal endoscopy in the Arab world

    Institute of Scientific and Technical Information of China (English)

    Mohamad-Iqbal S Miqdady; Wail A Hayajneh; Ruba Abdelhadi; Mark A Gilger

    2011-01-01

    AIM: To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world. METHODS: A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital, Jordan University of Science & Technology, Jordan was conducted. All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2. Analysis was performed in terms of sedation-related complications (desaturation, respiratory distress, apnea, bradycardia, cardiac arrest, emergence reactions), adequacy of sedation, need for sedation reversal, or failure to complete the procedure. RESULTS: A total of 301 patients (including 160 males) with a mean age of 9.26 years (range, 1-18 years) were included. All were premedicated with atropine; and 79.4% (239/301) had effective and uneventful sedation. And 248 (82.4%) of the 301 patients received a mean dose of 0.16 mg/kg (range, 0.07-0.39) midazolam and 1.06 mg/kg (range, 0.31-2.67) ketamine, respectively within the recommended dosage guidelines. Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female (F):19 male (M), P = 0.003] and ketamine in 2.7% (3 M:5 F). Maximum midazolam dose was more likely to be exceeded than ketamine (P 1 year and weighing > 10 kg without co-morbidities.

  13. Oral Midazolam Sedation For Uncooperative Children In Outpatient Paedodontics: Time For Reappraisal.

    Science.gov (United States)

    Kapur, Aditi; Jain, Kajal; Goyal, A; Mahoney, Greg

    2016-01-01

    Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'.

  14. Special care dentistry: Midazolam conscious sedation for patients with neurological diseases.

    Science.gov (United States)

    Capp, P L; de Faria, M E; Siqueira, S R; Cillo, M T; Prado, E G; de Siqueira, J T

    2010-12-01

    Midazolam is used very often to control the anxiety of patients for dental treatment, especially in patients with special needs. The objective of this study was to evaluate the efficiency of Midazolam in patients with neurological diseases referred for dental treatment. Descriptive study. Forty consecutive patients with neurological disorders (encephalopathy, autism, and epilepsy) were referred to dental treatment, and 45 sedations were performed; all were sedated with Midazolam (intramuscular 0.2-0.3 mg/kg or intravenous 0.1mg/kg) and all were anesthetised with lidocaine 2% (0.5-2 mL). During the dental procedure, their behavior was analysed and classified into 3 categories: A (indifferent), B (reacted but allowed treatment), and C (did not allow treatment). Data were tabbed and statistically analysed. The final patients' classification was: A 22 (49%), B 18 (40%) and C 5 (11%); the patients with encephalopathy had the best results of sedation according to the proposed classification (p<0.05). Midazolam demonstrated to be effective in 89% of this sample for dental procedures in patients with neurological and behavioral disturbances, but it was less effective for patients with autism (p<0.05).

  15. Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy.

    Science.gov (United States)

    Küçükyavuz, Zuhal; Cambazoğlu, Mine

    2004-06-01

    We studied the effects of low-dose midazolam with propofol for patient control sedation (PCS) in 30 healthy (ASA grade I) patients who were randomly allocated into two equal groups (n = 15 in each). They were given a propofol infusion of 2mg/kg/h after a bolus dose of 0.7 mg/kg. The second group was given the 2mg/kg/h propofol infusion after a dose of midazolam 0.03 mg/kg and a bolus dose of propofol 0.7 mg/kg. The standard dose for PCS was propofol 0.2mg/kg in both groups. Clinical data were taken and haemodynamic variables, and oxygen saturation were recorded before and on the 5th, 10th, 20th, and 30th minutes during the operations. The level of sedation, amnesia and conditions of each patient were evaluated during the study. Patients' satisfaction was recorded using a modified visual analogue scale (VAS). All results were evaluated statistically. We conclude that low-dose midazolam with propofol during PCS neither reduced oxygen saturation nor prolonged the time of discharge. Low-dose midazolam with propofol also improved the acceptability and comfort for patients and made the operation easier, which makes it preferable to propofol alone.

  16. Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients.

    Science.gov (United States)

    Tschirch, Frank T C; Göpfert, Kerstin; Fröhlich, Johannes M; Brunner, Genevieve; Weishaupt, Dominik

    2007-06-01

    The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (pclaustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form.

  17. Application to Add Midazolam to the Model List of Essential Medicines

    NARCIS (Netherlands)

    E.D. Wildschut (Enno); N.J. Vet (Nienke); S.N. de Wildt (Saskia)

    2011-01-01

    textabstractSummary statement of the proposal for inclusion The benzodiazepine midazolam has proven sedative, anxiolytic and amnesic properties. It is extensively used for premedication and procedural sedation in both adults and children. In comparison to other benzodiazepine and non-benzodiazepin

  18. Isoflurane compared with fentanyl-midazolam-based anesthesia in patients undergoing heart transplantation

    Science.gov (United States)

    Hsu, Che-Hao; Hsu, Yung-Chi; Huang, Go-Shine; Lu, Chih-Cherng; Ho, Shung-Tai; Liaw, Wen-Jinn; Tsai, Yi-Ting; Lin, Chih-Yuan; Tsai, Chien-Sung; Lin, Tso-Chou

    2016-01-01

    Abstract Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded. The perioperative variables and postoperative short-term outcomes were analyzed, including blood glucose levels, urine output, inotropic use, time to extubation, and length of stay in the intensive care units. After reviewing 112 heart transplantations, 18 recipients with fentanyl-midazolam-based anesthesia, and 29 receiving isoflurane anesthesia with minimal low-flow technique were analyzed. After cessation of cardiopulmonary bypass, recipients with isoflurane anesthesia had a significantly lower mean level and a less increase of blood glucose, as compared with those receiving fentanyl-based anesthesia. In addition, there was less use of dobutamine upon arriving the intensive care unit and a shorter time to extubation after isoflurane anesthesia. Compared with fentanyl-midazolam-based anesthesia, isoflurane minimal low-flow anesthesia maintained better perioperative homeostasis of blood glucose levels, less postoperative use of inotropics, and early extubation time among heart-transplant recipients without severe comorbidities. PMID:27583900

  19. Premedication with midazolam prior to caesarean section has no neonatal adverse effects.

    Science.gov (United States)

    Senel, Ahmet Can; Mergan, Fatih

    2014-01-01

    Like all surgical patients, obstetric patients also feel operative stress and anxiety. This can be prevented by giving patients detailed information about their operation and with preoperative pharmacological medications. Because of depressive effects of sedatives on newborns, pharmacological medications are omitted, especially in obstetric patients. The literature contains few studies concerning preoperative midazolam use in Caesarian section (C/S) patients. Our aim in this study was to help patients undergoing C/S surgery. One group scheduled for elective C/S received midazolam 0.025 mg kg(-1) intravenously, the other received saline. Maternal anxiety was evaluated using Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores, and newborns were evaluated using Apgar and the Neonatal Neurologic and Adaptive Capacity Score (NACS). In conclusion, patients receiving midazolam 0.025 mg kg(-1) as premedication had significantly low anxiety scores, without any adverse effects on the newborns. Midazolam can therefore safely be used as a premedicative agent in C/S surgery. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  20. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial.

    Science.gov (United States)

    Mokhtar, Ali M; Elsakka, Ahmed I; Ali, Hassan M

    2016-01-01

    Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns.

  1. Effects of ketamine, midazolam, thiopental, and propofol on brain ischemia injury in rat cerebral cortical slices

    Institute of Scientific and Technical Information of China (English)

    Qing-shengXUE; Bu-weiYU; Ze-jianWANG; Hong-zhuanCHEN

    2004-01-01

    AIM: To compare the effects of ketamine, midazolam, thiopental, and propofol on brain ischemia by the model of oxygen-glucose deprivation (OGD) in rat cerebral cortical slices. METHODS: Cerebral cortical slices were incu-bated in 2 % 2,3,5-triphenyltetrazolium chloride (TTC) solution after OGD, the damages and effects of ketamine,midazolam, thiopental, and propofol were quantitativlye evaluated by ELISA reader of absorbance (A) at 490 nm,which indicated the red formazan extracted from slices, lactic dehydrogenase (LDH) releases in the incubated supernate were also measured. RESULTS: Progressive prolongation of OGD resulted in decreases of TTC staining.The percentage of tissue injury had a positive correlation with LDH releases, r=0.9609, P<0.01. Two hours of reincubation aggravated the decrease of TTC staining compared with those slices stained immediately after OGD(P<0.01). These four anesthetics had no effects on the TTC staining of slices. Ketamine completely inhibited thedecrease of A value induced by 10 min of OGD injury. High concentrations of midazolam (10 μmol/L) and thiopental (400μmol/L) partly attenuated this decrease. Propofol at high concentration (100 μmol/L) enhanced the decrease of A value induced by 10 min of OGD injury (P<0.01). CONCLUSION; Ketamine, high concentration of midazolam and thiopental have neuroprotective effects against OGD injury in rat cerebral cortical slices, while high concentration of propofol augments OGD injury in rat cerebral cortical slices.

  2. Evidence of CYP3A Allosterism In Vivo: Analysis of Fluconazole and Midazolam Interaction

    Science.gov (United States)

    Yang, Jing; Atkins, William M.; Isoherranen, Nina; Paine, Mary F.; Thummel, Kenneth E.

    2013-01-01

    The allosteric effect of fluconazole (effector) on the formation of 1’-hydroxymidazolam (1’-OH-MDZ) and 4-hydroxymidazolam (4-OH-MDZ) from the CYP3A4/5 substrate, midazolam (MDZ), was examined in healthy volunteers. Following pre-treatment of fluconazole, AUC4-OH/AUCMDZ increased 35–62%, while AUC1’-OH/AUCMDZ decreased 5–37%; AUC1’-OH/AUC4-OH ratio decreased 46–58% by fluconazole and had no association with CYP3A5 genotype. 1’-OH-MDZ formation in vitro was more susceptible than 4-OH-MDZ formation to inhibition by fluconazole. Fluconazole decreased the intrinsic formation clearance ratio of 1’-OH-MDZ/4-OH-MDZ to an extent that was quantitatively comparable to in vivo observations. The elimination clearance of midazolam metabolites appeared unaffected by fluconazole. This study demonstrated that fluconazole alters midazolam product formation both in vivo and in vitro in a manner consistent with an allosteric interaction. The 1'-OH-MDZ/4-OH-MDZ ratio may serve as a biomarker of such interactions between midazolam, CYP3A4/5 and other putative effectors. PMID:22048224

  3. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    Science.gov (United States)

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Mixed-Effects Modeling of the Influence of Midazolam on Propofol Pharmacokinetics

    NARCIS (Netherlands)

    Vuyk, Jaap; Lichtenbelt, Bart Jan; Olofsen, Erik; van Kleef, Jack W.; Dahan, Albert

    BACKGROUND: The combined administration of anesthetics has been associated with pharmacokinetic interactions that induce concentration changes of up to 30%. Midazolam is often used as a preoperative sedative in advance of a propofol-based anesthetic. In this study, we identified the influence of

  5. Use of fentanyl and midazolam in mechanically ventilated children--Does the method of infusion matter?

    Science.gov (United States)

    da Silva, Paulo Sérgio Lucas; Reis, Maria Eunice; de Aguiar, Vânia Euzébio; Fonseca, Marcelo Cunio Machado

    2016-04-01

    Benzodiazepines and opioids are commonly used in pediatric intensive care unit. However, there is no previous study assessing the use of administering these drugs combined (single solution) or separately. We sought to evaluate the impact of these 2 different methods of providing sedation/analgesia in pediatric intensive care unit. One hundred twelve patients mechanically ventilated for more than 48 hours were randomized to receive a protocolized sedation regime comprising midazolam and fentanyl either separately (group 1, 57 patients) or combined as a single solution (group 2, 55 patients). Primary end point variable was the cumulated dose of midazolam and fentanyl. The median cumulated doses of both fentanyl (0.19 vs 0.37 mg/kg, P midazolam (28.8 vs 45.6 mg/kg, P midazolam and fentanyl had a higher cumulated dose of compared with those patients who did not. The potential risk for long-term neurologic effects on developing brains associated with this finding should be considered. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Effect of Sedation with Midazolam and Time to Discharge among Pediatric Dental Patients.

    Science.gov (United States)

    Blumer, Sigalit; Peretz, Benjamin; Zisman, Gali; Ratson, Tal

    The aim of this study was to examine the recovery time of children who underwent conscious sedation with oral or rectal midazolam. The medical files in the Department of Pediatric Dentistry of all the children who underwent conscious sedation with midazolam between 3/2013-4/2016 were examined. The total duration of sedation and time to discharge were calculated. Descriptions of the children's behavior before and during sedation were compared. The files of 120 children were retrieved. They included 64 girls, mean (± standard deviation) age 5.7 ± 2.67 years and 56 boys, mean age 4.9 ±1.06 years. The mean weight for the entire cohort was 18.7 ± 5.2 kg. Eighty-one children (67.5%) received oral sedation and 39 (32.5%) received rectal sedation. The mean total duration of sedation was 105 ± 26 min, and the mean time to discharge after treatment was 55:17 ± 22:30 min. A hundred and seven children exhibited positive behavior before undergoing sedation, but the behavior deteriorated during sedation in 36 cases. The time to discharge post-midazolam sedation correlated to the child's age and weight and total amount of administered midazolam. Sedation negatively affected behavior in 43.6% of the cases.

  7. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial

    Science.gov (United States)

    Mokhtar, Ali M.; Elsakka, Ahmed I.; Ali, Hassan M.

    2016-01-01

    Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns. PMID:27746564

  8. Fentanyl and Midazolam Are Ineffective in Reducing Episodic Intracranial Hypertension in Severe Pediatric Traumatic Brain Injury.

    Science.gov (United States)

    Welch, Timothy P; Wallendorf, Michael J; Kharasch, Evan D; Leonard, Jeffrey R; Doctor, Allan; Pineda, Jose A

    2016-04-01

    To evaluate the clinical effectiveness of bolus-dose fentanyl and midazolam to treat episodic intracranial hypertension in children with severe traumatic brain injury. Retrospective cohort. PICU in a university-affiliated children's hospital level I trauma center. Thirty-one children 0-18 years of age with severe traumatic brain injury (Glasgow Coma Scale score of ≤ 8) who received bolus doses of fentanyl and/or midazolam for treatment of episodic intracranial hypertension. None. The area under the curve from high-resolution intracranial pressure-time plots was calculated to represent cumulative intracranial hypertension exposure: area under the curve for intracranial pressure above 20 mm Hg (area under the curve-intracranial hypertension) was calculated in 15-minute epochs before and after administration of fentanyl and/or midazolam for the treatment of episodic intracranial hypertension. Our primary outcome measure, the difference between predrug and postdrug administration epochs (Δarea under the curve-intracranial hypertension), was calculated for all occurrences. We examined potential covariates including age, injury severity, mechanism, and time after injury; time after injury correlated with Δarea under the curve-intracranial hypertension. In a mixed-effects model, with patient as a random effect, drug/dose combination as a fixed effect, and time after injury as a covariate, intracranial hypertension increased after administration of fentanyl and/or midazolam (overall aggregate mean Δarea under the curve-intracranial hypertension = +17 mm Hg × min, 95% CI, 0-34 mm Hg × min; p = 0.04). The mean Δarea under the curve-intracranial hypertension increased significantly after administration of high-dose fentanyl (p = 0.02), low-dose midazolam (p = 0.006), and high-dose fentanyl plus low-dose midazolam (0.007). Secondary analysis using age-dependent thresholds showed no significant impact on cerebral perfusion pressure deficit (mean Δarea under the curve

  9. Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration.

    Science.gov (United States)

    Boku, Aiji; Inoue, Mika; Hanamoto, Hiroshi; Oyamaguchi, Aiko; Kudo, Chiho; Sugimura, Mitsutaka; Niwa, Hitoshi

    Intravenous sedation with propofol is often administered to anxious patients in dental practice. Pain on injection of propofol is a common adverse effect. This study aimed to determine the age-adjusted doses of midazolam required to erase memory of vascular pain of propofol administration and assess whether the Ramsay Sedation Scale (RSS) after the pretreatment of midazolam was useful to predict amnesia of the vascular pain of propofol administration. A total of 246 patients with dental phobia requiring dental treatment under intravenous sedation were included. Patients were classified according to their age: 30s, 40s, 50s, and 60s. Three minutes after administration of a predetermined dose of midazolam, propofol was infused continuously. After completion of the dental procedure, patients were interviewed about the memory of any pain or discomfort in the injection site or forearm. The dosage of midazolam was determined using the Dixon up-down method. The first patient was administered 0.03 mg/kg, and if memory of vascular pain remained, the dosage was increased by 0.01 mg/kg for the next patient, and then if the memory was erased, the dosage was decreased by 0.01 mg/kg. The effective dosage of midazolam in 95% of each age group for erasing the memory of propofol vascular pain (ED95) was determined using logistic analysis. The accuracy of RSS to predict the amnesia of injection pain was assessed by receiver operating characteristic (ROC) analysis. The ED95 of midazolam to erase the memory of propofol vascular pain was 0.061 mg/kg in patients in their 30s, 0.049 mg/kg in patients in their 40s, 0.033 mg/kg in patients in their 50s, and 0.033 mg/kg in patients in their 60s. The area under the ROC curve was 0.31. The ED95 of midazolam required to erase the memory of propofol vascular pain demonstrated a downward trend with age. On the other hand, it was impossible to predict the amnesia of propofol vascular pain using the RSS.

  10. Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia

    Science.gov (United States)

    Barzegari, Hassan; Masoumi, Kambiz; Motamed, Hassan; Zohrevandi, Behzad; Zeynadini Meymand, Shima

    2016-01-01

    Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. Results: 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg). Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects. PMID:27800539

  11. Comparison of Preanesthetic Sedation after Intranasal Administration of Fentanyle, Ketamin and Midazolam

    Directory of Open Access Journals (Sweden)

    F Javaherforoosh

    2006-07-01

    Full Text Available Introduction & Objective: Induction of anesthesia in children can be a challenge for anesthetist. A stormy induction may increase the personality & behavioral changes. Therefore, it is desirable that they enter the operating room sedated. Many drugs are used for preanesthetic medication and there are many routes for administration. One route of administration is nasal mucous. In this study we compared the effect and side effect of three drugs (midazolam, ketamin and fentanyle after intra nasal administration. Materials & Methods: This is a double blind clinical trial. In this study we selected 60 patients (20 patients for every group A, B or C. We used 3 mg/kg ketamin or 3µg/kg fentanyle or 0.3 mg/kg midazolam by intranasal spray. After administration and in 5, 10 and 15 minutes, we observed the SPO2, PR and RR. After 15 min’s we separated children from parents and brought them to the operating room and controlled the acceptance of separation, depth of sedation with Ramsay score, acceptance of mask and tolerance of IV canulation. The data were then analyzed using K2 and kruskal-wallis test. Results: In our study we found that in SPO2 fentanyle had the highest rate of reduction even though none of the children had SPO2 lower than 90%. There were no differences between drugs in RR. In fentanyle group, we had the lowest rate and in ketamin group the highest rate. Midazolam had the medium rate. The rate of sedation for acceptance of separation from parents had no difference between the groups and all drugs with this dosage were effective for this aim. However, in Ramsay score, acceptance of mask and tolerance of IV canulation, the midazolam was more effective than the others. Conclusion: Intranasal administration of midazolam is a safe route for sedation in children in the pre-anesthetic time.

  12. Comparison between the effect of propofol and midazolam on picrotoxin-induced convulsions in rat.

    Science.gov (United States)

    Hasan, Zuheir A; Abdel Razzak, Rima L; Alzoubi, Karem H

    2014-04-10

    Propofol is a short acting intravenous anesthetic that has been used in the treatment of status epileptics. However, the occurrence of seizures in epileptic and non-epileptic patients during recovery from propofol induced anesthesia suggests that propofol may have proconvulsant effects. We have previously shown that propofol displays anticonvulsant effects against picrotoxin (PTX) induced seizures during its peak sedative effects. The purpose of the present study was to compare the time course of the effect of intravenous administration of various doses (2.5, 5, and 10 mg/kg) of propofol and midazolam on PTX-induced seizures in adult female Sprague-Dawley rats. The latency to onset of clonic seizures induced by intraperitoneal injection of PTX was significantly increased by the highest dose of propofol and all doses of midazolam, suggesting that both agents display anticonvulsant effects. The anticonvulsant effects of propofol (10 mg/kg) lasted about 20 min and PTX-induced clonic seizures were observed thereafter and peaked within 30 min post drug administration. Clonic seizures progressed rapidly to tonic seizures leading to high rate of PTX-induced mortality. In midazolam (10 mg/kg) treated rats, clonic seizures were observed 25 min after drug administration and the number of rats exhibiting clonic seizures was highest within 40 min. However, clonic seizures did not progress into tonic seizures and thus, PTX-induced seizure related mortality was significantly reduced. In conclusion, this study provides further evidence for the anticonvulsant effects of propofol and midazolam against PTX-induced seizures. Furthermore, the data of the current study showed that midazolam was more effective than propofol against PTX-induced tonic seizures.

  13. Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

    Science.gov (United States)

    Ettinger, Kyle S; Jacob, Adam K; Viozzi, Christopher F; Van Ess, James M; Fillmore, W Jonathan; Arce, Kevin

    2015-12-01

    To evaluate the impact of intravenous midazolam dose on the duration of recovery room stay for patients undergoing outpatient third molar surgery. Using a retrospective cohort study design, a sample of patients undergoing outpatient third molar surgery under intravenous sedation at Mayo Clinic from 2010 to 2014 was identified. All patients underwent extraction of all 4 third molars during a single operative procedure and the age range was limited to 14 to 29 years. The primary predictor variable was the total dose of intravenous midazolam administered during sedation. The primary outcome variable was recovery room length of stay (LOS) after completion of surgery. Multiple covariates also abstracted included patient age, gender, American Society of Anesthesiologists (ASA) score, duration of surgical procedure, complexity of surgical procedure, types and dosages of all intravenous medications administered during sedation, and volume of crystalloid fluid administered perioperatively. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary outcome variable. The study sample was composed of 2,610 patients. Mean age was 18.3 years (SD, 3.0 yr; range, 14 to 29 yr) and gender distribution was 52% female. Mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). Variables predicting shorter LOS at multivariable analysis included older age (P midazolam administered during sedation was not found to be significantly associated with prolonged recovery room LOS in univariable or multivariable settings. Dosage of intravenous midazolam does not appear to significantly impact the duration of recovery room stay in the prototypical patients undergoing sedation for outpatient third molar surgery. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Duerden, Emma G; Guo, Ting; Dodbiba, Lorin; Chakravarty, M Mallar; Chau, Vann; Poskitt, Kenneth J; Synnes, Anne; Grunau, Ruth E; Miller, Steven P

    2016-04-01

    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 0.5 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. © 2016 American Neurological Association.

  15. Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

    Directory of Open Access Journals (Sweden)

    Mahmoud Hassan Mohamed

    2014-01-01

    Conclusion: We concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.

  16. RANDOMIZED DOUBLE BLIND CLINICAL TRIAL OF INTRAMUSCULAR DEXMEDETOMIDINE V/S MIDAZOLAM AS PREMEDICATION IN PAEDIATRIC SURGICAL PATIENTS

    Directory of Open Access Journals (Sweden)

    Anmol

    2016-05-01

    Full Text Available OBJECTIVE A genuine attempt was made to find ideal drug for premedication in paediatric surgical patients. Dexmedetomidine a newer, highly selective alpha-2 agonist was compared to midazolam via intramuscular route. Setting: Institute-Department of Anaesthesiology, Krishna Institute of Medical Sciences. METHODS Dexmedetomidine group (Group D with the conventional Midazolam group (Group M was compared for premedication in cases of paediatric surgical patients. A total of sixty patients, scheduled for elective surgery of duration 15 to 90 minutes, were enrolled and randomly assigned in a double blind manner to Group D and Group M. Intramuscular Dexmedetomidine (1.5 mcg/kg in Group D or midazolam (0.05 mg/kg in Group M, as a premedication in preoperative room was given and sedation score with Ramsay sedation scale and parent separation anxiety score were recorded. After 45 mins, patient was shifted in the operation room and a standard technique of anaesthesia was applied to all patients. Mask acceptance score, wake up score, demand of post-op analgesia, time for first analgesia requirement were recorded. RESULTS Our study comparing dexmedetomidine with midazolam premedication found a stable heart rate and blood pressure with comparable sedative effects, (90% vs 56%, P value 0.0074 concluded that dexmedetomidine group had better sedative effect. Parent separation anxiety score was better with dexmedetomidine group compared to midazolam group with p value 0.0419 (93% vs 70%. Mask acceptance was better with dexmedetomidine group compared to midazolam group with p value 0.0153 (90% vs 60%. Wake up score were compared and dexmedetomidine was better than midazolam with p value 0.0001 (93% vs 46%. CONCLUSION Premedication with low-dose intramuscular dexmedetomidine resulted in better sedation, lower anxiety levels during parent separation, better mask acceptance and wake up behaviour as compared with low-dose intramuscular midazolam.

  17. Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Hsiao-Chien Tsai

    Full Text Available Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy.Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK according to the PRISMA guidelines.Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51 and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54 than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol.This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam.

  18. A COMPARISON OF THE EFFECTS OF THE PROPOFOL VERSUS MIDAZOLAM DURING TOTAL INTRAVENOUS ANESTHESIA FOR GYNECOLOGICAL SURGERY PROCEDURES

    Institute of Scientific and Technical Information of China (English)

    叶铁虎; 龚志毅; 金永芳; 王玲; 任洪智; 罗爱伦

    1995-01-01

    The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA Ⅰ - Ⅱ patlents undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol group (P n=20) and rnidazolam group (M n=20) randomly. The anesthesia was designed for each group respectively. Here, we discuss the experimental method and the results, which indicate that propofol is not only an effective anesthetic but also has more rapid and head-cleat recovery properties than midazolam.

  19. Changes to the bispectral index and regional cerebral blood flow in a sedative state, caused by midazolam administration

    OpenAIRE

    池田, 淳子; イケダ, ジュンコ; Junko, IKEDA

    2006-01-01

    Psychosedation, as used in the field of dentistry, is intended to provide trouble-free dental care while maintaining a proper level of sedation. One drug used in psychosedation is midazolam, which is known to have a strong amnestic effect. In the current research, I sought to clarify whether the bispectral index (BIS) using EEC analysis can be used for assessment of optimal sedation in psychosedation, and what effects midazolam has on the cerebrum's mechanism of memory. The subjects were 17 h...

  20. SEDOANALGESIA CON KETAMINA-MIDAZOLAM-FENTANILO EN RATONES. CARACTERÍSTICAS Y SEGUIMIENTO POR UNA PLANILLA DE REGISTRO

    OpenAIRE

    Elena GA; Colucci DG; Harvey G; Echaniz G; Fini C; Consiglio F; Puig NR

    2014-01-01

    Ketamine-midazolam-fentanyl sedoanalgesia in mice. Characteristics and follow up by a specially designed anesthetic chart. The aim of this work was to analyze the characteristics of ketamine-midazolam-fentanyl sedoanalgesia in puber, adult and 200 days old mice. Variables were recorded in a specially designed anesthetic chart, where complementary physiological information was also recorded. Latency to achieve unconsciousness and blockade of motor response to a noxious stimulus was regist...

  1. Propofol versus Midazolam for Upper Gastrointestinal Endoscopy in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Tsai, Hsiao-Chien; Lin, Yu-Cih; Ko, Ching-Lung; Lou, Horng-Yuan; Chen, Ta-Liang; Tam, Ka-Wai; Chen, Chien-Yu

    2015-01-01

    Background Sedation during gastrointestinal endoscopy is often achieved using propofol or midazolam in general population. However, impaired protein synthesis, altered drug metabolism, and compromised hepatic blood flow in patients with liver cirrhosis might affect the pharmacokinetics of sedatives, placing cirrhotic patients undergoing endoscopy at a greater risk of adverse events. The objective of this study was to assess comparative efficacies and safety of propofol and midazolam in cirrhotic patients undergoing endoscopy. Methods Randomized, controlled trials comparing propofol with midazolam in cirrhotic patients undergoing gastrointestinal endoscopy were selected. We performed the meta-analysis, using a random-effect model, the Review Manager, Version 5.2, statistical software package (Cochrane Collaboration, Oxford, UK) according to the PRISMA guidelines. Results Five studies between 2003 and 2012, including 433 patients, were included. Propofol provided a shorter time to sedation (weight mean difference: -2.76 min, 95% confidence interval: -3.00 to -2.51) and a shorter recovery time (weight mean difference -6.17 min, 95% confidence interval: -6.81 to -5.54) than midazolam did. No intergroup difference in the incidence of hypotension, bradycardia, or hypoxemia was observed. Midazolam was associated with the deterioration of psychometric scores for a longer period than propofol. Conclusion This meta-analysis suggests that Propofol sedation for endoscopy provides more rapid sedation and recovery than midazolam does. The risk of sedation-related side effects for propofol does not differ significantly from that of midazolam. The efficacy of propofol in cirrhotic patients undergoing endoscopy is superior to those of midazolam. PMID:25646815

  2. Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate

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    Mahmoud Reza ASHRAFI

    2013-02-01

    Full Text Available How to Cite This Article: AshrafiMR, Azizi Malamiri R, Zamani GR, Mohammadi M, Hosseini F. Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate. Iran J Child Neurol. 2013 Winter;7(1:15-19.ObjectiveElectroencephalography (EEG recording is a long duration procedure that needs patient’s cooperation for device setup and performing the procedure. Many children lose their cooperation during this procedure. Therefore, sedation and sleep are frequently induced using a few agents as pre procedure medication in children before EEG recording. We aimed to compare the sedative effects of oral midazolam versus chloral hydrate before the procedure along with their impacts on EEG recording in children.Materials & MethodsA randomized trial was carried out to compare the sedative effects of oral midazolam versus chloral hydrate and their impacts on EEG recording in children. A total of 198 children (100 in the midazolam group and 98 in the chloral hydrate group were enrolled in the study and randomly allocated to receive either oral moidazolam or chloral hydrate.ResultsOral midazolam had superiority neither in sleep onset latency nor in sleep duration when compared to chloral hydrate. Moreover, the yield of epileptiform discharges in the chloral hydrate group was more than the midazolam group.ConclusionThe results of this study showed that both chloral hydrate 5% (one ml/kg and oral midazolam (0.5 mg/kg could be administered as a pre medication agent for EEG recording in children. However, oral midazolam at this dose had no advantage compared with chloral hydrate.ReferencesAshrafi MR, Mohammadi M, Tafarroji J, Shabanian R, Salamati P, Zamani GR. Melatonin versus chloral hydrate for recording sleep EEG. Eur J Paediatr Neurol 2010;14(3:235-8.Slifer KJ, Avis KT, Frutchey RA. Behavioral intervention to increase compliance with electroencephalographic procedures in children with developmental disabilities. Epilepsy

  3. Lack of meaningful effect of ridaforolimus on the pharmacokinetics of midazolam in cancer patients: model prediction and clinical confirmation.

    Science.gov (United States)

    Stroh, Mark; Talaty, Jennifer; Sandhu, Punam; McCrea, Jacqueline; Patnaik, Amita; Tolcher, Anthony; Palcza, John; Orford, Keith; Breidinger, Sheila; Narasimhan, Narayana; Panebianco, Deborah; Lush, Richard; Papadopoulos, Kyriakos P; Wagner, John A; Trucksis, Michele; Agrawal, Nancy

    2014-11-01

    Ridaforolimus, a unique non-prodrug analog of rapamycin, is a potent inhibitor of mTOR under development for cancer treatment. In vitro data suggest ridaforolimus is a reversible and time-dependent inhibitor of CYP3A. A model-based evaluation suggested an increase in midazolam area under the curve (AUC(0- ∞)) of between 1.13- and 1.25-fold in the presence of therapeutic concentrations of ridaforolimus. The pharmacokinetic interaction between multiple oral doses of ridaforolimus and a single oral dose of midazolam was evaluated in an open-label, fixed-sequence study, in which cancer patients received a single oral dose of 2 mg midazolam followed by 5 consecutive daily single oral doses of 40 mg ridaforolimus with a single dose of 2 mg midazolam with the fifth ridaforolimus dose. Changes in midazolam exposure were minimal [geometric mean ratios and 90% confidence intervals: 1.23 (1.07, 1.40) for AUC(0-∞) and 0.92 (0.82, 1.03) for maximum concentrations (C(max)), respectively]. Consistent with model predictions, ridaforolimus had no clinically important effect on midazolam pharmacokinetics and is not anticipated to be a perpetrator of drug-drug interactions (DDIs) when coadministered with CYP3A substrates. Model-based approaches can provide reasonable estimates of DDI liability, potentially obviating the need to conduct dedicated DDI studies especially in challenging populations like cancer patients.

  4. Evaluation of hypothermia on the in vitro metabolism and binding and in vivo disposition of midazolam in rats.

    Science.gov (United States)

    Miyamoto, Hirotaka; Matsueda, Satoshi; Moritsuka, Akihiro; Shimokawa, Kenta; Hirata, Haruna; Nakashima, Mikiro; Sasaki, Hitoshi; Fumoto, Shintaro; Nishida, Koyo

    2015-10-01

    The effect of hypothermia on the in vivo pharmacokinetics of midazolam was evaluated, with a focus on altered metabolism in the liver and binding to serum proteins. Rat primary hepatocytes were incubated with midazolam (which is metabolized mainly by CYP3A2) at 37, 32 or 28 °C. The Michaelis-Menten constant (Km) and maximum velocity (Vmax) of midazolam were estimated using the Michaelis-Menten equation. The Km of CYP3A2 midazolam remained unchanged, but the Vmax decreased at 28 °C. In rats, whose temperature was maintained at 37, 32 or 28 °C by a heat lamp or ice pack, the plasma concentrations of midazolam were higher, whereas those in the brain and liver were unchanged at 28 °C. The tissue/plasma concentration ratios were, however, increased significantly. The unbound fraction of midazolam in serum at 28 °C was half that at 37 °C. These pharmacokinetic changes associated with hypothermic conditions were due to reductions in CYP3A2 activity and protein binding.

  5. Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients: A retrospective study.

    Science.gov (United States)

    Gao, Yang; Kang, Kai; Liu, Haitao; Jia, Liu; Tang, Rong; Zhang, Xing; Wang, Hongliang; Yu, Kaijiang

    2017-06-01

    This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n  =  72) and midazolam (n  =  76) groups according to sedative mode. The sedative effects, incidence of adverse events, and bronchoscopist satisfaction scores were compared between groups.During FFB, total sedation time and total time of FFB were significantly shorter in the midazolam group (P midazolam group (P  =  .007, .014 and .008, respectively). However, the incidence of other adverse events was not significantly different between groups. In addition, bronchoscopist satisfaction scores were significantly higher in the midazolam compared with dexmedetomidine group (7.72 ± 1.65 vs 7.08 ± 1.77; P  =  .030).For sedation of ICU patients during FFB, combination of midazolam and dexmedetomidine demonstrated an enhanced sedative effect, lower incidence of adverse events, and higher bronchoscopist satisfaction score compared with dexmedetomidine alone, thus represents a suitable alternative sedative for FFB patients.

  6. Lidocaine Pretreatment Reduces the Discomfort of Intranasal Midazolam Administration: A Randomized, Double-blind, Placebo-controlled Trial.

    Science.gov (United States)

    Smith, David; Cheek, Hugh; Denson, Brenda; Pruitt, Christopher M

    2017-02-01

    Intranasal (IN) midazolam is a commonly prescribed medication for pediatric sedation and anxiolysis. One of its most frequently encountered adverse effects is discomfort with administration. While it has been proposed that premedicating with lidocaine reduces this undesirable consequence, this combination has not been thoroughly researched. The objective of our study was to assess whether topical lidocaine lessens the discomfort associated with IN midazolam administration. This was a double-blind, randomized, placebo-controlled trial performed in an urban, academic pediatric emergency department. Children 6-12 years of age who were receiving IN midazolam for procedural sedation received either 4% lidocaine or 0.9% saline (placebo) via mucosal atomizer. Subjects were subsequently given IN midazolam in a similar fashion and then rated their discomfort using the Wong-Baker FACES Pain Rating Scale (WBS). The primary endpoint of WBS score was analyzed with a two-tailed Mann-Whitney U-test, with p midazolam administration (median WBS = 3, interquartile range [IQR] = 0-6) than those who received placebo (median WBS = 8, IQR = 2-9; p = 0.006). Premedication with topical lidocaine reduces the discomfort associated with administration of IN midazolam (ClinicalTrials.gov, NCT02396537). © 2016 by the Society for Academic Emergency Medicine.

  7. Premedicación en anestesia pediátrica: citrato de fentanilo oral transmucoso frente a midazolam oral Premedication in paediatric anaesthesia

    Directory of Open Access Journals (Sweden)

    I. Velázquez

    2010-04-01

    Full Text Available Introducción: La premedicación anestésica está destinada a reducir la ansiedad y la respuesta al estrés que supone el período anterior a la intervención quirúrgica. El temor a lo desconocido, al dolor y la separación de los padres son elementos que se añaden a la ansiedad perioperatoria en la población pediátrica. La necesidad de encontrar una vía de administración idónea en niños que no añada más sufrimientos a los ya existentes, es un reto para los anestesiólogos. Objetivo: Los objetivos del presente estudio eran valorar la eficacia, el grado de sedación y el modo de aceptación de 2 modalidades de premedicación para niños: citrato de fentanilo oral transmucoso (CFOT y midazolam oral disuelto en zumo de fruta. Material y método: Se estudiaron 2 grupos aleatorizados de 40 niños que iban a someterse a cirugía de diversas especialidades. Las dosis administradas fueron de 10 μg/kg de CFOT y 0,3 mg/kg de midazolam, administrados 30 minutos antes de la punciσn venosa. Las variables consideradas fueron: saturaciσn de hemoglobina desde el inicio de la premedicaciσn y en la sala de despertar, modo de aceptaciσn, grado de sedaciσn, actitud del niρo al separarlo de los padres, ante la punción venosa y ante la inducción anestésica, retraso en el despertar, requerimiento de analgesia postoperatoria, aparición de efectos secundarios. Resultados: Los resultados se compararon utilizando la t de Student (p Introduction: The aim of anaesthetic premedication is to reduce anxiety and stress prior to surgery. Paediatric patients suffer even more anxiety due to fear of the unknown and the separation from parents. The need to find out a suitable way of administering premedication to paediatric patients without causing any more trauma is a challenge for the anaesthesiologist. Objectives: The objective of the current study was to evaluate the efficacy, level of sedation and a way of accepting two different types of premedication for

  8. Comparison of Analgesic Efficacy of Dexmedetomidine and Midazolam as Adjuncts to Lignocaine for Intravenous Regional Anesthesia

    Science.gov (United States)

    Gupta, Bharti; Verma, Ravinder Kumar; Kumar, Sudershan; Chaudhary, Geeta

    2017-01-01

    Background: Intravenous regional anesthesia (IVRA) is safe, technically simple, and cost-effective technique compared to general anesthesia with success rates of 94–98% for upper and lower limb surgeries. The main disadvantage of this procedure is its limited duration for surgery, lack of postoperative analgesia, and tourniquet pain. To overcome this disadvantage, various adjuvants to lignocaine have been studied from time to time. Aim: To compare the analgesic efficacy of dexmedetomidine and midazolam as adjuncts to lignocaine for IVRA for forearm and hand surgeries. Setting and Design: The study was conducted by the Department of Anaesthesia of Medical College and patients posted for elective as well as the emergency forearm and hand surgeries were included in the study. It was a prospective comparative study. Materials and Methods: Sixty patients of either sex belonging to the American Society of Anesthesiologists Class I and II, in the age range of 18–65 years, scheduled for upper limb orthopedic surgery, either elective or emergency, were included in the study. All patients were administered IVRA in this prospective, double-blind, randomized study. Patients enrolled in the study were randomly divided into two groups of thirty each. Group M-received 40 ml of 0.5% lignocaine with midazolam 50 μg/kg and Group D-received 40 ml of 0.5% lignocaine with dexmedetomidine 1 μg/kg. Time of onset of sensory block, duration of analgesia, total dose of fentanyl given, intraoperative blood pressure, oxygen saturation, heart rate, postoperative analgesia, and adverse effects were recorded and compared between the groups. Statistical Analysis Used: The statistical evaluation was performed using SPSS version 17.0 software. All values were calculated with a 95% confidence interval. The parameters were expressed as mean ± standard deviation and t-test was used for comparing demographic and clinical data. For comparisons, P < 0.05 was considered statistically significant

  9. The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study.

    Science.gov (United States)

    Taipale, Priscilla G; Ratner, Pamela A; Galdas, Paul M; Jillings, Carol; Manning, Deborah; Fernandes, Connie; Gallaher, Jaime

    2012-09-01

    Post-operative delirium after cardiac surgery is an adverse event that affects patients' recovery and complicates the delivery of nursing care. Numerous risk factors for delirium are uncontrollable; however, nurses' pro re nata drug administration of sedatives may be a controllable risk factor. This study examined the relationship between nurses' pro re nata administration of midazolam hydrochloride to cardiac surgery patients and the development of post-operative delirium. Observational study. Cardiac surgery intensive care and nursing units of a tertiary care center in Vancouver, Canada. 122 male and female patients requiring non-emergent surgery for coronary artery disease or valvular heart disease who did not have pre-existing cognitive impairment, severe hearing or visual impairment, substance misuse, alcohol intake exceeding 7 drinks per week, or renal impairment requiring hemodialysis. Patients were assessed for delirium, on three occasions, with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 h after surgery and through reviews of physicians' notes. Risk factor and midazolam dosage data were collected from medical records. 77.9% of the patients in this sample received midazolam hydrochloride post-operatively. The prevalence of delirium ranged from 37.7% to 44.3%. Almost all of the dosages of midazolam (85-87%) were given before the first indication of delirium; that is, most of the patients had received their entire dosage before the first signs of delirium were detected. Bivariate analysis with logistic regression models revealed that for every additional milligram of midazolam administered, the patients were 7-8% more likely to develop delirium. Multivariate logistic regression models demonstrated that the magnitude of the association between midazolam dosage and delirium was not confounded by established risk factors including age and peripheral vascular disease. Nurses play an important role in the prediction

  10. VACUNACIÓN CONTRA EL VIRUS DEL PAPILOMA HUMANO Y AUTOINMUNIDAD

    Directory of Open Access Journals (Sweden)

    Juan-Manuel Anaya

    2014-10-01

    Full Text Available El desarrollo de enfermedades autoinmunes es un tema de suma importancia cuando de vacunas se trata, dado el riesgo que pueden tener éstas de favorecer fenómenos de autoinmunidad en individuos susceptibles. La relación riesgo/beneficio de desarrollar enfermedades autoinmunes luego de la vacunación contra el virus del papiloma humano (VPH aún no se ha resuelto. Los datos disponibles son limitados para ofrecer conclusiones definitivas. Dado el aumento reciente de reporte de efectos adversos, se espera que estudios con suficiente tamaño muestral, en diversas poblaciones, confirmen la seguridad de la vacunación contra el VPH en niñas con enfermedades autoinmunes. Un análisis personalizado de cada paciente, que incluya la evaluación de autoinmunidad personal y familiar, podría ser sugerido, aunque no hay estudios que demuestren que sea costo-efectivo. Por lo tanto, la farmacovigilancia permanente de esta vacuna sigue siendo de suma importancia.

  11. Comparison of sedation scores and propofol induction doses in dogs after intramuscular administration of dexmedetomidine alone or in combination with methadone, midazolam, or methadone plus midazolam.

    Science.gov (United States)

    Canfrán, S; Bustamante, R; González, P; Cediel, R; Re, M; de Segura, I A Gómez

    2016-04-01

    The objectives of this study were to determine: (1) the sedative effects of dexmedetomidine in combination with methadone, midazolam, or both, and (2) the propofol dose required to achieve endotracheal intubation in healthy dogs. Seven healthy Beagle dogs were included in a prospective experimental, crossover, randomised and masked design. All dogs received four treatments IM, with at least 1 week between sessions, as follows: dexmedetomidine 5 µg/kg (D) alone, or combined with methadone 0.3 mg/kg (DMe), midazolam 0.3 mg/kg (DMi), or both (DMeMi). The degree of sedation was evaluated using a numerical scale (maximum 15 points). The dose of propofol required for intubation was also calculated for each group. Recovery time and quality were determined. Statistical analysis was performed using parametric (ANOVA) and nonparametric tests (Friedman, Cochran Q), as appropriate. The degree of sedation obtained with DMe and DMeMi (13, [7-14]; 13, [6-14], respectively) was significantly higher than in the control group (2, [1-4]; P = 0.023, P = 0.006, respectively). The required dose of propofol was lower in all groups (DMi, 1.5 ± 0.5 mg/kg, P = 0.002; DMe, 1.2 ± 0.5 mg/kg, P midazolam did not enhance the sedative effects of dexmedetomidine or a dexmedetomidine-methadone combination at the doses studied, and propofol requirements were reduced. The sedative effect of dexmedetomidine was enhanced with methadone, and the required dose of propofol was reduced. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Pharmacokinetics cannot explain the increased effective dose requirement for morphine and midazolam in rats during their extended administration alone or in combination.

    Science.gov (United States)

    Schaller, Stefan J; Alam, Saad M; Mao, Jianren; Zhao, Yanli; Blobner, Manfred; Greenblatt, David J; Martyn, J A Jeevendra

    2017-01-01

    Chronic administration of morphine and midazolam, alone or in combination, can induce tolerance to their effects. Data showed that co-administration of morphine and midazolam increased effective dose requirement of morphine, exceeding that observed with morphine alone. To elucidate the pharmacokinetic component to the tolerance, we administered midazolam (2 mg/kg) and morphine (10 mg/kg) alone or their combination daily to rats for 12 days followed by a pharmacokinetic study on day 13. On the study day, each animal received a single bolus dose of 5 mg/kg morphine, and 2 mg/kg of midazolam 30 s later. Multiple blood samples were obtained for 6 h. Plasma drug concentrations were assayed by mass spectrometry optimized for small samples. Mean morphine clearance was as follows: 22.2, 27.2, 26.0 and 23.4 l/h per kg in the saline-saline, saline-midazolam, saline-morphine and midazolam-morphine groups, respectively. Corresponding midazolam clearances were 32.8, 23.0, 22.2 and 31.1 l/h per kg. ANOVA indicated no significant differences among the four groups in the clearances, half-lives, and volumes of distribution. Morphine and midazolam clearances were significantly correlated (R(2) = 0.48, P midazolam, when administered alone or combination, for extended periods. © 2016 Royal Pharmaceutical Society.

  13. The Comparison Of Total Intravenous Anesthesia (Propofol, Alfentanyl Plus Midazolam, Alfentanyl With General Anesthesia In D&C Patients

    Directory of Open Access Journals (Sweden)

    Shoeibi G

    2004-07-01

    Full Text Available Background: Total Intravenous Anesthesia (TIVA compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia. Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group or alfentanyl plus midazolam (midazolam group Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05, also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05. After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P0.05 also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05. Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05. Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies

  14. [Diprivan versus midazolam in combined anaesthesia with ketamin for minor gynecological surgery].

    Science.gov (United States)

    Tablov, V; Tsafarov, M; Tablov, B; Popov, I; Partenov, P

    2007-01-01

    We tested the hypothesis that diprivan/ketamine (D/K) anesthesia would offer advantages compared to midazolam/ketamine (M/K) in patients undergoing minor gynecological surgery. After patient written consent, 60 healthy women, which were scheduled for elective termination of pregnancy were randomly allocated into two groups. Operating conditions, recovery, pain, postoperative nausea and vomiting (PONV) and patient's satisfaction to anesthesia were assessed. Demographic and surgical data were identical in the groups. Immediate recovery was faster with patients given diprivan than midazolam. Patients receiving M/K experienced more PONV in recovery room. D/K is preferable method of anesthesia for ultra-short gynecological procedure compared to M/K because of faster recovery and decreased incidence of PONV.

  15. Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

    DEFF Research Database (Denmark)

    Secher, Niels; Malte, Christian Lind; Tønnesen, Else

    2016-01-01

    CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. METHODS: Male Sprague Dawley rats were randomized to anesthesia with isoflurane (n=11) or fentanyl...... samples for Endothelin-1 and cathecolamines were drawn before and after CA. KEY FINDINGS: Compared with fentanyl/fluanisone/midazolam anesthesia, isoflurane resulted in a shorter time to return of spontaneous circulation (ROSC), less use of epinephrine, increased coronary perfusion pressure during CPR......, higher mean arterial pressure post ROSC, increased plasma levels of Endothelin-1 and decreased levels of epinephrine. The choice of anesthesia did not affect ROSC rate or systemic O2 consumption. CONCLUSION: Isoflurane reduces time to ROSC, increases coronary perfusion pressure, and improves hemodynamic...

  16. Effects of premedication of midazolam or clonidine on perioperative anxiety and pain in children.

    Science.gov (United States)

    Cao, Jianping; Shi, Xueyin; Miao, Xiaoyong; Xu, Jia

    2009-06-01

    The aim of the present study was to compare clinical effects of oral midazolam and clonidine premedication in children. In a prospective randomized double blind trial, 45 children between 2-8 years old received either oral midazolam 0.5 mg/kg (group M) or clonidine at 2 microg/kg (group C 2) or 4 microg/kg (group C4). The level of sedation, quality of parental separation, mask acceptance and thermodynamics were recorded. Postoperative analgesia, and perioperative side effects were assessed. In comparison to group M, the scores of sedation, parental separation and mask acceptance were significantly higher in group C2 and group C4 (p clonidine premedication can therefore provide better preoperative sedation and postoperative analgesia with few adverse effects.

  17. Exacerbation of benign familial neonatal epilepsy induced by massive doses of phenobarbital and midazolam.

    Science.gov (United States)

    Maeda, Tomoki; Shimizu, Miki; Sekiguchi, Kazuhito; Ishii, Atsushi; Ihara, Yukiko; Hirose, Shinichi; Izumi, Tatsuro

    2014-08-01

    Barbiturates and benzodiazepines are the first-line anticonvulsants for neonatal seizures. However, in immature brains, those drugs may lead to paradoxical neuronal excitation. A patient with benign familial neonatal epilepsy developed epileptic encephalopathy after massive doses of phenobarbital that were followed by a continuous infusion of midazolam on postnatal day 3. Electroencephalography revealed rhythmic delta activity in clusters with migrating epileptic foci. After discontinuation of both drugs, the patient's consciousness promptly improved and her electroencephalography normalized on postnatal day 5. This baby developed persistent electroencephalographic seizures due to massive doses of phenobarbital and midazolam. Clinicians should be aware of this anticonvulsant-induced paradoxical neuronal excitation and the uncoupling phenomenon, especially in individuals with benign familial neonatal epilepsy, who have low seizure thresholds. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Conscious midazolam sedation in third molar surgery--aspects of post-operative patient evaluation.

    Science.gov (United States)

    Bremerich, A; Hierl, T

    1995-09-01

    This study was conducted on 426 patients undergoing third molar surgery to evaluate their opinion on surgery and the follow-up period concerning postoperative behaviour, pain, and complaints. Two groups were formed as patients had to choose between local anaesthesia only or additional conscious sedation by means of intravenous midazolam (0.1 mg/kg). Women and younger patients preferred conscious sedation. Surgery was described as significantly less distressing by the sedated group. No difference in the evaluation of the follow-up period between both groups existed. Patients of the midazolam group took more analgesics, tended to stay longer in bed and reported on protracted cooling. Non-sedated persons older than 30 years complained about a slower decrease in postoperative pain. According to these findings, sensitive, cautious patients tend to prefer conscious sedation which is reflected in their behaviour. No relationship between the evaluation of surgery itself and the follow-up period could be found.

  19. Efficacy and safety of midazolam for sedation in pediatric dentistry: a controlled clinical trial.

    Science.gov (United States)

    Azevedo, Isabelita Duarte; Ferreira, Maria Angela Fernandes; da Costa, Anna Paula Serejo; Bosco, Vera Lúcia; Moritz, Rachel Duarte

    2013-01-01

    Pharmacological management of uncooperative children is becoming increasingly common in the dental setting. The purpose of this study was to determine the efficacy and safety of 3 different doses of midazolam for sedation in 2- to 4- year-old children with multiple dental needs and negative behavior. Ten children participated in this crossover, controlled, double-blinded clinical trial, which evaluated their behavior, appointment length and patient response after administration of 3 different doses of midazolam or placebo. Oxygen saturation, heart rate, respiratory rate, and blood pressure were monitored in all sessions. Sedated children exhibited a more positive behavior compared to the placebo group, both at the beginning of the appointment (sitting in the chair) and during administration of local anesthesia (P=.008 and Ppediatric sedation in the dosages studied.

  20. The Influence of a Combined Butorphanol and Midazolam Premedication on Anesthesia in Psittacid Species.

    Science.gov (United States)

    Kubiak, Marie; Roach, Louise; Eatwell, Kevin

    2016-12-01

    Premedication is considered routine for domestic animal and human anesthesia but is rarely applied to avian patients, and few controlled studies exist to document effects of premedication in avian species. To determine the effects of a butorphanol and midazolam premedication on general anesthesia and quality of induction and recovery phases in psittacid species, 17 clinically healthy birds undergoing anesthesia were randomly allocated into either a premedicated or control group. Anesthetic parameters were subsequently compared. Induction time and isoflurane concentration required for anesthetic maintenance were reduced in the premedicated group. Induction quality scores were improved in the premedicated group and no adverse effects on anesthesia and cardiovascular stability were observed. Use of a combined butorphanol and midazolam premedication in clinically healthy psittacine birds appears safe and effective. Premedication provides a beneficial effect at induction and enables maintenance levels of anesthetic gas to be reduced.

  1. A COMPARATIVE STUDY BETWEEN ORAL CLONIDINE AND ORAL MIDAZOLAM AS PREMEDICANT IN CHILDREN

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    Gurudatta

    2015-08-01

    Full Text Available Majority of Paediatric patients experience significant anxiety in the preoperative holding area and during induction of anesthesia. Such anxiety often prolongs the induction of Anesthesia, increases post - operative pain and produces negative behavioral changes in chil dren. Effective premedication is the answer, which permits less traumatic separation of child from parents and facilitates smooth induction of anesthesia. The aim of the study is to evaluate and compare the efficacy of oral clonidine v/s oral midazolam adm inistered as a pre medicant in children. METHODS: 100 patients of ASA group I/II of either sex between the age group 4 years to 12 years scheduled for elective surgery were divided into two groups. (1 Group C received tablet oral clonidine 4μg/kg mixed wi th 5 ml of water 90 minutes before the induction. (2 Group M – received oral midazolam syrup 0.5mg/kg 45 minutes before the induction. Both the groups were assessed for: (1 drug acceptance (2 sedation score (3 anxiety score (4 onset of sedation (5 ma sk acceptance (6 Cardio respiratory scoring (7 OPS scoring (8 Parental acceptance. The results were statistically analysed. CONCLUSION: Premedication with oral clonidine is a suitable alternative to oral midazolam. It has several advantages compared to oral midazolam, like better acceptance of the drug by the children, adequate sedation and anxiolysis, easy acceptance of mask and I.V. cannulation, minimal side effects, adequate analgesia, good parental satisfaction. One disadvantage of clonidine is slowe r onset of action

  2. Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

    OpenAIRE

    Wawrzyniak, Katarzyna; Kusza, Krzysztof; Cywinski, Jacek B.

    2014-01-01

    Objectives Premedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery. Methods Forty-four patients undergoing ESS fo...

  3. A Comparison of Dexmedetomidine Sedation With and Without Midazolam for Dental Implant Surgery

    OpenAIRE

    Wakita, Ryo; Kohase, Hikaru; Fukayama, Haruhisa

    2012-01-01

    Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three s...

  4. Effects of midazolam and phenobarbital on brain oxidative reactions induced by pentylenetetrazole in a convulsion model.

    Science.gov (United States)

    Arai, Yukiko; Maeda, Shigeru; Higuchi, Hitoshi; Tomoyasu, Yumiko; Shimada, Masahiko; Miyawaki, Takuya

    2012-04-01

    Brain oxidative reactions are involved in epilepsy as well as neurodegenerative diseases. In animal convulsion models, some anticonvulsants have been found to suppress oxidative reactions associated with convulsions. However, the effect of anticonvulsants on brain oxidative reactions has not fully been clarified. Midazolam and phenobarbital are often used as an intravenous anesthetic, and are known to have anticonvulsive effect, but antioxidative effect of these drugs has rarely been studied. Thus, the purpose of this study was to evaluate the effects of these drugs on the degree of convulsions and brain oxidative reactions in an animal convulsion model. In order to evaluate brain oxidative reactions, we measured malondialdehyde (MDA) level and heme oxygenase (HO)-1 mRNA expression level in the brain of mice in a convulsion model generated by a single injection of pentylenetetrazole (PTZ). We evaluated the effects of midazolam and phenobarbital on the degree of PTZ-induced convulsions and on the changes in brain MDA level and HO-1 mRNA expression level. After PTZ injection, severe convulsions were observed in all mice. MDA level was increased in the whole brain, while HO-1 mRNA expression level was increased only in the hippocampus. Both midazolam and phenobarbital prevented the convulsions and suppressed the increase in both MDA level and HO-1 mRNA expression level in the brain. In this study, both midazolam and phenobarbital suppressed PTZ-induced MDA and HO-1 reactions in the brain, suggesting that these drugs inhibit brain oxidative reactions in a convulsion model.

  5. Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.

    Science.gov (United States)

    Sackey, P V; Radell, P J; Granath, F; Martling, C R

    2007-06-01

    Bispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa or intravenous midazolam. BIS (A-2000 XP, version 3.12), electromyogram activity (EMG) and Signal Quality Index were measured continuously. Hourly clinical evaluation of sedation depth according to Bloomsbury Sedation Score (Bloomsbury) was performed. The median BIS value during a 10-minute interval prior to the clinical evaluation at the bedside was compared with Bloomsbury. Nurses performing the clinical sedation scoring were blinded to the BIS values. End-tidal isoflurane concentration was measured and compared with Bloomsbury. Correlation was poor between BIS and Bloomsbury in both groups (Spearman's rho 0.012 in the isoflurane group and -0.057 in the midazolam group). Strong correlation was found between BIS and EMG (Spearman's rho 0.74). Significant correlation was found between end-tidal isoflurane concentration and Bloomsbury (Spearman's rho 0.47). In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non-paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non-paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.

  6. Intravenous midazolam sedation in pediatric diagnostic upper digestive endoscopy. A prospective study in a general hospital.

    Science.gov (United States)

    Verhage, Jan; Mulder, Chris J J; Willekens, Frans L A

    2003-12-01

    The positive role of benzodiazepines (Midazolam) in conscious sedation in pediatric patients is widely known. However, problems concerning the role of sedation in diagnostic upper endoscopy are a matter for debate as little is known about dosage and timing. We prospectively evaluated the efficacy, safety and optimal intravenous sedation dosage of midazolam in 257 consecutive patients, aged 2 months to 18 years old, who underwent upper endoscopy of the gastrointestinal tract. The initial midazolam dosage was 0.2 mg/kg Bw (Body weight) i.v. for 1 minute and, if necessary, another 0.1 mg/kg Bw was administered 5 minutes later. If sedation was sufficient, the procedure would be started 4-5 minutes later; if not, another 0.1 - 0.2 mg/kg Bw would be administered. All procedures were performed by a pediatrician together with a gastroenterologist. No serious complications occurred in any of the procedures. Oxygen saturation (OS) was maintained at over 90%, if necessary with blowby oxygen. Flumazenil was administered to 7 children (OS < 90%). Endoscopy could not be completed in 1 child. All endoscopies were completed within 10 minutes. No unexpected hospital admissions were necessary. The mean midazolam dosage was 0.4 mg/kg Bw in patients up to 6 years, for the over 6 years-olds the mean dosage was decreased to 0,2 mg/kg Bw. Particular attention was paid to the importance of informing patients before the procedure. Endoscopic diagnostic procedures can be performed safely and effectively in children with intravenous sedation in a well equipped pediatric endoscopy unit.

  7. Remifentanil-midazolam sedation provides hemodynamic stability and comfort during epicardial ablation of ventricular tachycardia.

    Science.gov (United States)

    Mandel, Jeff E; Hutchinson, Mathew D; Marchlinski, Francis E

    2011-04-01

    Epicardial ablation of ventricular tachycardia (VT) presents multiple challenges for anesthetic management. General anesthesia lowers blood pressure, may interfere with arrhythmia mapping, and use of muscle relaxants precludes identification of the phrenic nerve. We describe a case in which remifentanil with minimal doses of midazolam was employed in a series of epicardial VT ablations and noninvasive programmed stimulations (NIPS), including 5 external cardioversions and discuss the advantages of this approach.

  8. Influence of the antibiotics erythromycin and azithromycin on the pharmacokinetics and pharmacodynamics of midazolam.

    Science.gov (United States)

    Zimmermann, T; Yeates, R A; Laufen, H; Scharpf, F; Leitold, M; Wildfeuer, A

    1996-02-01

    The pharmacokinetic and pharmacodynamic interaction between azithromycin (CAS 83905-01-5), an azalide antibiotic, and midazolam (CAS 59467-70-8), a short-acting hypnotic agent, was investigated in an open, three-way cross-over study, including erythromycin (CAS 114-07-8) as a positive control. Twelve healthy male and female subjects had standard doses of azithromycin (500 mg o.d. over 3 days), or erythromycin (500 mg t.i.d. over 5 days), or no pretreatment. On the day of the last dose, they ingested 15 mg midazolam. Blood samples were collected and psychometric tests performed. Erythromycin pretreatment (E) significantly changed the pharmacokinetics of midazolam compared to control (C), whereas azithromycin (A) had no such effect. The parameters are summarized as follows: area under the concentration-time curve, AUC (C) 173.8 h.ng.ml-1 vs. (E) 662.7 h.ng.ml-1*+ and (A) 220.0 h.ng.ml-1; concentration maxima (C) 67.2 ng.ml-1 vs. (E) 182.3 ng.ml-1*+ and (A) 86.7 ng.ml-1; elimination half-life (C) 2.21 h vs. (E) 4.85 h* and (A) 2.41 h (* p < 0.05 vs. (C), +p < 0.05 vs. (A)). Pharmacodynamic tests (digit symbol substitution test; critical flicker fusion test; subjective analog scale for rating of alertness; duration of sleep) consistently showed significant differences after erythromycin pretreatment compared to control, but not after azithromycin. Erythromycin, but not azithromycin, causes clinically significant changes in the pharmacokinetics and pharmacodynamics of midazolam.

  9. The Relationship of Intravenous Midazolam and Posttraumatic Stress Disorder Development in Burned Soldiers

    Science.gov (United States)

    2009-04-01

    nervous system. GABA receptors exist in the cerebral cortex, the hippocampus , the amygdala, the thalamus, the and brain stem. Activation of GABAA receptors... hippocampus . Benzodiazepines are used for various reasons including anxiety and stress-related disorders. Midazolam is associated with...usage in mil- ligrams was calculated by adding the amount of ketamine received in the operating room. Intraoperative morphine equivalent units from the

  10. Evaluation of Intranasal Midazolam as an Anesthetic Premedication in Preschool Children

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    Sh Behdad

    2005-10-01

    Full Text Available Introduction: Preoperative psycho emotional preparation of patients is one of the principle purposes of anesthesia which can be achieved by administration of premedications. Children should receive premedication before entering the operating room due to their dependence on parents and the fear and anxiety of separation from parents. Different drugs are administered for this purpose, but considering children's sensitivity, it is wise to use the most effective and comfortable medication with least side effects. Midazolam is a rapid onset, short acting and water soluble benzodiazapine which can be administered by oral, intravenous, intramuscular, rectal or intranasal routes. The purpose of this study was to evaluate the result of intranasal midazolam administration (0.2 mg/kg as a premedication in children aged 2-6 years.( Min dose and enough time Methods: In this randomized prospective study, 100 children aged between 2-6 years old in class ASA 1 and candidates of surgery were divided into two groups; case and control. The control group received several nasal drops of normal saline, while the case group received 0.2 mg/kg nasal midazolam 20 minutes before anesthesia induction. Results: Twenty minutes after administration of the nasal drops, 14% in the control group and 68% in the case group were alert and calm. (P value=0.0 . Mask acceptance during induction of anesthesia in control and case group was 14%and 72%, respectively (P value >0.00 The recovery time in the case group was longer (P value >0.5, but no complications (nausea, vomiting, respiratory and cardiovascular problems were seen in either group. Conclusion: Nasal midazolam with its anxiolytic, tranquilizing effects and no respiratory or cardiovascular complications is a safe drug and being better than parenteral drugs is acceptable by children.

  11. THE CARDIOVASCULAR EFFECTS OF MIDAZOLAM CO-INDUCTION TO PROPOFOL FOR INDUCTION IN GERIATRIC PATIENTS

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    Kaushal

    2014-10-01

    Full Text Available : BACKGROUND: The aim of the study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent the cardiovascular change at tracheal intubation for induction in geriatric patients. METHODS: ninety patients over 65 (ASA physical status 1, 2 scheduled for elective surgery received general anaesthesia with fentanyl and propofol or midazolam. Patients in group P (n= 45 were induced with 0.9% NaCl 0.03 ml /kg, propofol 1.2 mg/kg and fentanyl. Patients in group MP (n= 45 were induced with midazolam 0.03 mg/ kg, propofol 0.8 mg/kg and fentanyl. The time taken to reach loss of consciousness (LOC. After LOC 0.5 mg/kg of atracurium was given and tracheal intubation was performed. The mean blood pressure (MBP and heart rate (HR were recorded were induction as the base value, before intubation, immediately post intubation and 3 minutes after intubation. RESULT: compared with the base values, MBP at before intubation and # 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 was no significant difference of HR at any time between the two groups. CONCLUSION: co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in geriatric patients.

  12. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

    OpenAIRE

    Lightdale, Jenifer R; Mitchell, Paul D; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Lisa Scharff; Fox, Victor L

    2011-01-01

    Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ...

  13. Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure: a randomized clinical trial.

    Science.gov (United States)

    Javadzadeh, Mohsen; Sheibani, Kourosh; Hashemieh, Mozhgan; Saneifard, Hedyeh

    2012-03-01

    Acute seizure attack is a stressful experience both for health care personnel and parents. These attacks might cause morbidity and mortality among patients, so reliable methods to control the seizure preferably at home should be developed. This study was performed to measure the time needed to control seizure attacks using intranasal midazolam compared to the common treatment (intravenous diazepam) and to evaluate its probable side effects. This study was conducted as a not blind randomized clinical trial among 60 patients coming to Imam Ali Hospital, Zahedan, Iran. The patients were 2 months to 15 years old children coming to our emergency department suffering from an acute seizure episode. Intranasal midazolam was administered 0.2 mg/kg equally dropped in both nostrils for case group and intravenous diazepam was administered 0.3mg/kg via IV line for control group. After both treatments the time needed to control the seizure was registered by the practitioner. Pulse rate and O2 saturation were recorded at patients' entrance and in minutes 5 and 10 after drug administration. The time needed to control seizure using intranasal midazolam (3.16±1.24) was statistically shorter than intravenous diazepam (6.42±2.59) if the time needed to establish IV line in patients treated by intravenous diazepam is taken into account (P<0.001). The readings for O2 saturation or heart rate did not indicate a statistically significant difference between two groups of patients either at entrance or 5 and 10 minutes after drug administration. Considering the shorter time needed to control acute seizure episodes compared to intravenous diazepam and its safety record, intranasal midazolam seems to be a good candidate to replace diazepam, as the drug of choice, in controlling this condition.

  14. IS ATOMIZED INTRANASAL MIDAZOLAM A NOVEL SEDATIVE PREMEDICATION IN PAEDIATRIC PATIENTS?

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    Savitri D. Kabade

    2017-06-01

    Full Text Available BACKGROUND The successful conduct of anaesthesia in children depends on adequate premedication, which not only comforts the anxious child but also comforts the parents or guardians. Atomized Intranasal Midazolam is quickly absorbed through the nasal mucosa, resulting in a rapid and reliable onset of action. Clonidine has several applications in paediatric anaesthesia as a premedication and as an adjuvant in general as well as regional anaesthesia. Thus, in search of a novel premedication technique, we conducted a study to compare the effectiveness of atomized intranasal midazolam with intranasal clonidine for preoperative sedation in paediatric patients undergoing elective surgery. MATERIALS AND METHODS After obtaining Institutional Ethical Committee clearance and parent’s consent, a prospective, randomised, double-blinded clinical study was conducted in 78 children of ASA I and II, belonging to 2 - 10 years age, posted for various elective surgery. Group M (n= 39 received atomized intranasal midazolam (0.3 mg/kg and Group C (n= 39 received clonidine (4 mcg/kg instilled into both the nostrils. Sedation score (Ramsay, separation score, mask acceptance, recovery and vital parameters were recorded. Statistical analysis of data was done using IBM-SPSS version 21.0. RESULTS Mean sedation scores (± SD were higher in Group M than in Group C (at 5th minute 1.58 ± 0.55 in Group M and 1.15 ± 0.36 in Group C with P= 0.002, at 10th minute 2.34 ± 0.97 in Group M and 1.75 ± 0.71 in Group C with P= 0.008. Separation scores and mask acceptance were better with Group M than Group C. Haemodynamic parameters were similar in both the groups and no major adverse effects were noted. CONCLUSION Atomized intranasal midazolam produces superior sedation levels, child-parent separation and mask acceptance compared to intranasal clonidine in children.

  15. Allosteric activation of midazolam CYP3A5 hydroxylase activity by icotinib - Enhancement by ketoconazole.

    Science.gov (United States)

    Zhuang, XiaoMei; Zhang, TianHong; Yue, SiJia; Wang, Juan; Luo, Huan; Zhang, YunXia; Li, Zheng; Che, JinJing; Yang, HaiYing; Li, Hua; Zhu, MingShe; Lu, Chuang

    2016-12-01

    Icotinib (ICO), a novel small molecule and a tyrosine kinase inhibitor, was developed and approved recently in China for non-small cell lung cancer. During screening for CYP inhibition potential in human liver microsomes (HLM), heterotropic activation toward CYP3A5 was revealed. Activation by icotinib was observed with CYP3A-mediated midazolam hydroxylase activity in HLM (∼40% over the baseline) or recombinant human CYP3A5 (rhCYP3A5) (∼70% over the baseline), but not in the other major CYPs including rhCYP3A4. When co-incubated with selective CYP3A4 inhibitor CYP3cide or monoclonal human CYP3A4 inhibitory antibody in HLM, the activation was extended to ∼60%, suggesting CYP3A5 might be the isozyme involved. Further, the relative activation was enhanced to ∼270% in rhCYP3A5 in the presence of ketoconazole. The activation was substrate and pathway dependent and observed only in the formation of 1'-OH-midazolam, and not 4-OH-midazolam, 6β-OH-testosterone, or oxidized nifedipine. The activation requires the presence of cytochrome b5 and it is only observed in the liver microsomes of dogs, monkeys, and humans, but not in rats and mice. Kinetic analyses of 1'-OH-midazolam formation showed that ICO increased the Vmax values in HLM and rhCYP3A5 with no significant changes in Km values. By adding CYP3cide with ICO to the incubation, the Vmax values increased 2-fold over the CYP3cide control. Addition of ketoconazole with ICO alone or ICO plus CYP3cide resulted in an increase in Vmax values and decrease in Km values compared to their controls. This phenomenon may be attributed to a new mechanism of CYP3A5 heterotropic activation, which warrants further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Sufentanil and midazolam dosing and pharmacogenetic factors in pediatric analgosedation and withdrawal syndrome.

    Science.gov (United States)

    Hronová, K; Pokorná, P; Posch, L; Slanař, O

    2016-12-21

    Our aim was to describe the effect of dosing and genetic factors on sufentanil- and midazolam-induced analgosedation and withdrawal syndrome (WS) in pediatric population. Analgosedation and withdrawal syndrome development were monitored using COMFORT-neo/-B scores and SOS score. Length of therapy, dosing of sufentanil and midazolam were recorded. Genotypes of selected candidate polymorphisms in CYP3A5, COMT, ABCB1, OPRM1 and PXR were analysed. In the group of 30 neonates and 18 children, longer treatment duration with midazolam of 141 h (2 - 625) vs. 88 h (7 - 232) and sufentanil of 326.5 h (136 - 885) vs. 92 h (22 - 211) (median; range) was found in the patients suffering from WS vs. non-WS group, respectively. Median midazolam cumulative doses were in the respective values of 18.22 mg/kg (6.93 - 51.25) vs. 9.94 mg/kg (2.12 - 49.83); P=0.03, and the respective values for sufentanil were 88.60 microg/kg (20.21 - 918.52) vs. 21.71 microg/kg (4.5 - 162.29); P<0.01. Cut off value of 177 hours for sufentanil treatment duration represented predictive factor for WS development with 81 % sensitivity and 94 % specificity. SNPs in the candidate genes COMT, PXR and ABCB1 affected the dosing of analgosedative drugs, but were not associated with depth of analgosedation or WS. Cumulative dose and length of analgosedative therapy with sufentanil significantly increases the risk of WS in critically ill neonates and children.

  17. Comparison of Behavior and Dental Anxiety During Intranasal and Sublingual Midazolam Sedation - A Randomized Controlled Trial.

    Science.gov (United States)

    Shanmugaavel, A K; Asokan, Sharath; Baby, John J; Priya, Geetha; Gnana Devi, J

    2016-01-01

    The objective of the study was to assess the behavioral effects and the changes in the anxiety level of children after intranasal and sublingual midazolam sedation using Venham's clinical anxiety scale and salivary cortisol level. Twenty children aged 3 to 7 years were randomly assigned to Group A (n=10) intranasal or Group B (n=10) sublingual midazolam (0.2mg/kg) sedation. The anxiety levels at various time periods were assessed using Venham clinical anxiety scale and corresponding changes in salivary cortisol levels were assessed before and after the drug administration. The anxiety levels were assessed independently by two pediatric dentists from recorded videos. Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis using SPSS version 19.0. There was a significant decrease in anxiety level from baseline to 20 minutes after drug administration in group A (p=0.004) and group B (p=0.003). There was no significant change in salivary cortisol levels before and after the drug administration in group A (p=0.07) and group B (p=0.38). Both intranasal and sublingual administration of midazolam was equally effective in reducing the child's anxiety. However, there was no significant difference in the salivary cortisol levels in both groups.

  18. [Propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy].

    Science.gov (United States)

    Xiao, Dinghua; Wang, Fen; Wang, Xiaoyan; Tang, Wuliang; Ouyang, Wen; Shen, Shourong

    2009-07-01

    To explore the application of propofol combined with midazolam intravenous anesthesia in pediatric upper gastrointestinal endoscopy. A total of 497 ASA I~II patients who received sedative upper gastrointestinal endoscopy were assigned to a children group (2-14 years) and an adults group (18-65 years).The 2 groups were treated with midazolam (0.02-0.03 mg/kg, iv) and propofol(0.6-0.7 mg/s,iv) with an interval of 3-5 minutes. Enterscopy was inserted at light sleep, relaxing muscles, and disappearance of eyelash relaxation. Combining of pro-endoscopy, reaction to intravenous administration, dose of propofol, reaction to endoscopy, time of returning to consciousness, changes of SpO2, R, HR, and BP, and sedative quality were evaluated. Good sedation of the 2 groups after intravenous administration was observed. Rate of combining of pro-endoscopy in children was lower (42%) than that in adults(100%). The incidence of restlessness, hyperphasia, temporary decreasing of SpO2, dose of propofol of per kilogram weight, time of returning to consciousness in the children were 82.7%, 17%, 2.4 mg/kg, and (17.5+/-3.2) min, respectively, which were all higher in the adults [9%, 4%, 1.4 mg/kg, and (9.5+/-1.3) min, P0.05). It is safe and effective to use propofol combined with midazolam intravenous sedation anesthesia in pediatric upper gastrointestinal endoscopy.

  19. Comparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index.

    Science.gov (United States)

    Fan, Tai Weng Victor; Ti, Lian Kah; Islam, Intekhab

    2013-07-01

    Although various sedative drugs in different regimens and given by different delivery routes have been used for conscious sedation, the ideal agent and regimen remain to be established. This study was designed to compare the efficacy (sedation, anxiolysis, analgesia, operating conditions, and patients' satisfaction) and safety of midazolam and dexmedetomidine as sedatives for dental procedures in a randomised, double-blind study in third molar and dental implant surgery. Sixty healthy patients who were American Society of Anesthesiologists (ASA) group I or II were enrolled and we recorded their personal details, the amount of drug used, their degree of satisfaction, duration of operation, and haemodynamic and respiratory variables. The two groups were comparable. The amount of local anaesthetic (p=0.11) and the duration of operation did not differ significantly (p=0.32). The patients in the dexmedetomidine group had a slower heart rate, lower systolic and diastolic pressure, and cooperated better. There were no significant differences in their respiratory rates, bispectral index, and total volume of drugs used. We conclude that dexmedetomidine works as well as midazolam for outpatient dental procedures and can be used as an alternative to midazolam.

  20. Effect of maraviroc on the pharmacokinetics of midazolam, lamivudine/ zidovudine, and ethinyloestradiol/ levonorgestrel in healthy volunteers

    Science.gov (United States)

    Abel, Samantha; Russell, Deborah; Whitlock, Lyndsey A; Ridgway, Caroline E; Muirhead, Gary J

    2008-01-01

    Aims To assess the effect of maraviroc on the pharmacokinetics of midazolam, a sensitive probe CYP3A4 substrate; lamivudine/zidovudine, a combination of nucleoside reverse transcriptase inhibitors (NRTIs); and ethinyloestradiol/levonorgestrel, a combination oral contraceptive. Methods Three randomized, double-blind, placebo-controlled studies were conducted in healthy subjects to assess the effect of maraviroc on pharmacokinetics of other drugs. Two, two-period crossover studies were conducted to assess (i) the effect of steady-state maraviroc (300 mg b.i.d.) on pharmacokinetics of midazolam; and (ii) the effect of steady-state maraviroc (300 mg b.i.d.) on the pharmacokinetics of lamivudine/zidovudine. A third two-way crossover study was conducted to evaluate the effect of steady-state maraviroc (100 mg b.i.d.) on the pharmacokinetics of 30 μg ethinyloestradiol/150 μg levonorgestrel (Microgynon®). Results The geometric mean ratios for Cmax and AUC for each of the compounds tested in the presence and absence of maraviroc were between 92% and 121%. There were no notable differences in Tmax, t1/2 or CLR (where measured) for any of the compounds. Conclusions Maraviroc had no clinically relevant effects on the pharmacokinetics of the CYP3A4 substrate midazolam, the NRTIs zidovudine/lamivudine, or the oral contraceptive steroids ethinyloestradiol and levonorgestrel. PMID:18333862

  1. Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Gharavifard

    2016-04-01

    Full Text Available Introduction: Performance of painful diagnostic and therapeutic procedures is common in emergency department(ED, and procedural sedation and analgesia (PSA is a fundamental skill for every emergency physician.This studywas aim to compare the efficacy of remifentanil with fentanyl/midazolam in painless reduction of anteriorshoulder dislocation. Methods: In this randomized, double blind, clinical trial the procedural characteristics,patients satisfaction as well as adverse events were compared between fentanyl/midazolamand remifentanilfor PSA of 18–64 years old patients, which were presented to ED following anterior shoulder dislocation.Results: 96 cases were randomly allocated to two groups (86.5% male. There were no significant difference betweengroups regarding baseline characteristics. Remifentanil group had lower duration of procedure (2.5§1.6versus 4.6§1.8 minutes, p Ç 0.001, higher pain reduction (53.7§13.3 versus 33.5§19.6, p Ç 0.001, lower failurerate (1 (2.1% versus 15 (31.3%, p Ç 0.001, higher satisfaction (p Æ 0.005. Adverse events were seen in 12 (25%patients in midazolam/fentanyl and 8 (16.7% cases in remifentanil group (p Æ 0.122. Conclusion: It seemsthat use of remifentanil resulted in lower procedural time, lower failure rate, and lower pain during procedureas well as higher patient satisfaction in comparison with midazolam/fentanyl combination in anterior shoulderdislocation.

  2. Hyperalgesic effect induced by barbiturates, midazolam and ethanol: pharmacological evidence for GABA-A receptor involvement

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    M.A.K.F. Tatsuo

    1997-02-01

    Full Text Available The involvement of GABA-A receptors in the control of nociception was studied using the tail-flick test in rats. Non-hypnotic doses of the barbiturates phenobarbital (5-50 mg/kg, pentobarbital (17-33 mg/kg, and thiopental (7.5-30 mg/kg, of the benzodiazepine midazolam (10 mg/kg or of ethanol (0.4-1.6 g/kg administered by the systemic route reduced the latency for the tail-flick response, thus inducing a 'hyperalgesic' state in the animals. In contrast, non-convulsant doses of the GABA-A antagonist picrotoxin (0.12-1.0 mg/kg administered systemically induced an increase in the latency for the tail-flick response, therefore characterizing an 'antinociceptive' state. Previous picrotoxin (0.12 mg/kg treatment abolished the hyperalgesic state induced by effective doses of the barbiturates, midazolam or ethanol. Since phenobarbital, midazolam and ethanol reproduced the described hyperalgesic effect of GABA-A-specific agonists (muscimol, THIP, which is specifically antagonized by the GABA-A antagonist picrotoxin, our results suggest that GABA-A receptors are tonically involved in the modulation of nociception in the rat central nervous system

  3. Propofol Versus Midazolam/Fentanyl Sedation for Colonoscopy in the Elderly Patient Population.

    Science.gov (United States)

    Lovett, Pamela; Gómez, Victoria; Hodge, David O; Ladlie, Beth

    2017-06-01

    Despite current literature, data on the most effective sedation and best patient outcomes are insufficient for providing recovery time recommendations for elderly patients undergoing colonoscopy with sedation. We sought to identify the best sedation practice for shorter recovery times. Therefore, a study was conducted to examine recovery times among patients older than 65 years undergoing elective colonoscopy with intravenous sedation with either propofol or the combination of midazolam/fentanyl. A retrospective descriptive, exploratory design was used. We retrospectively reviewed data from patients older than 65 years undergoing outpatient elective colonoscopy at our institution between January and December 2013. Recovery times were evaluated for those administered intravenous propofol or a combination of midazolam/fentanyl. Patient demographics and sedation medications were obtained from patient records. A modified Aldrete score greater than 8 was required for discharge. Recovery time was defined as the time from procedure completion to a modified Aldrete score greater than 8. Propofol sedation was associated with longer recovery times compared with sedation with a combination of midazolam and fentanyl (mean: 50 minutes versus 31 minutes, P < .001). Propofol sedation was not associated with shorter recovery times. Further studies are needed to validate these findings. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. Comparison of the sedative effects of midazolam and dexmedetomidine during regional anaesthesia

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    Mehmet Korkmaz

    2011-06-01

    Full Text Available The aim of this study was to compare the efficacy of dexmedetomidine versus midazolam for sedation under spinal anesthesia for arthroscopic knee surgery.Materials and methods: Fifty adult patients, 18 to 65 years, were randomized into two groups: Group M received 0.04 mg/kg iv bolus midazolam followed by administration of 0.5 mg boluses to provide Ramsay sedation Scale (RSS 3-4. Group D received dexmedetomidine loading dose of 1 μg/kg/h over 10 minutes and the maintenance dose of 0.2-0.7 μg/kg/h to achieve an adequate level of RSS 3-4. Recovery was evaluated with Modified Aldrete Scale. Pain was scored using Verbal rating scale (VRS. Postoperative VRS and Quality of Recovery (QoR were recorded. Patients were asked to fill the questionnaire that included 4 questions, and patient satisfaction was rated with VRS.Results: Heart rate and mean blood pressure values were found to be decreased in group D when compared with Group M (p0.05.Conclusion: The present study showed that dexmedetomidine provided similar parameters of recovery and patient satisfaction equivalent to midazolam without negative effects on hemodynamic and respiratory functions.

  5. The effect of auricular acupuncture on pain during colonoscopy with midazolam and pethidine

    Science.gov (United States)

    Kusumastuti, R.; Srilestari, A.; Abdurrohim, K.; Abdullah, M.

    2017-08-01

    Colonoscopy is the standard procedure for colorectal cancer screening. One of its common complications is abdominal pain. Analgesia has not provided favorable outcomes so various complementary practices have been developed, including auricular acupuncture. In this study, a randomized controlled trial of 56 patients who underwent colonoscopy was conducted to determine the effect of acupuncture on the pain experienced during colonoscopy. Subjects were divided into two groups: The first received acupuncture combined with midazolam and pethidine, while the second were administered placebo puncture in addition to midazolam and pethidine. The median Critical Care Pain Observation Tool (CPOT) score was lower in the auricular acupuncture group than in the placebo puncture group(0.7 [0-4.83] vs. 1.9 [0-6.20] p = 0.010), while there were no significant differences to median Visual Analog Scale (VAS) scores (29 [0-100] vs. 44.5 [0-100] p = 0.147), heart rate changes (-2.58 [14.31] vs.-2.43 [12.28]; p = 0.970), or the mean time to the cecum (16 [8-51] vs. 22 [5-63] p = 0.206). Auricular acupuncture combined with midazolam and pethidine was found to be effective at reducing pain during colonoscopy.

  6. Flumazenil used in the antagonizing of diazepam and midazolam sedation in out-patients undergoing gastroscopy.

    Science.gov (United States)

    Jensen, S; Knudsen, L; Kirkegaard, L

    1988-01-01

    In two double-blind, randomized trials the efficacy and safety of flumazenil, the first benzodiazepine antagonist, were assessed in 100 adult patients undergoing gastroscopy under diazepam or midazolam sedation. The criteria of efficacy were the degree of sedation and anterograde amnesia. The median gastroscopy time was 20 min (range 5-40 min). The diazepam group received median 30 mg (range 15-60 mg) Diazemuls and the midazolam group median 15 mg (range 10-40 mg) Dormicum. Both groups were antagonized by median 0.42 mg flumazenil (range 0.4-0.6 mg). There was no inter-group difference with regard to blood pressure, heart rate and respiration rate. There was a significantly faster recovery of the patients after injection of flumazenil than after placebo. Patients were awake shortly after flumazenil, but remained drowsy or asleep after placebo administration. All patients, regardless of diazepam or midazolam sedation, antagonized with flumazenil were awake within 5 min and remained awake during the whole observation period of 3 h. The amnesia was totally eliminated by flumazenil. There were no significant differences in side-effects between the groups.

  7. Comparison of midazolam sedation with or without fentanyl in cataract surgery.

    Science.gov (United States)

    Cok, O Yalcin; Ertan, A; Bahadir, M

    2008-01-01

    We compared the effect of midazolam sedation with or without fentanyl on the hemodynamic parameters, sedation, and pain and satisfaction profile in cataract surgery. Two hundred and ten patients were randomly allocated to receive either midazolam 1 mg i.v. (Group M, n = 101) alone or with fentanyl 25 microg (Group MF, n = 100) before retrobulbar injection. Hemodynamic parameters, observer's assessment of alertness/sedation (OAA/S) scores, pain during block and surgery, satisfaction of patient and surgeons were assessed. Heart rate and diastolic arterial pressure decreased after retrobulbar injection in comparison to baseline whereas systolic arterial pressure values increased in both groups. The majority of patients in both groups experienced mild pain during retrobulbar injection but no pain during surgery. There was a significant decrease in OAA/S scores in both groups (p = 0.001) and this decline was more significant in Group MF (p = 0.038). We suggest that midazolam alone may produce optimal block conditions for the patient and it is satisfactory during the procedure while the addition of fentanyl has not improved the effect on the examined parameters.

  8. The influence of high spinal anesthesia on sensitivity to midazolam sedation.

    Science.gov (United States)

    Ben-David, B; Vaida, S; Gaitini, L

    1995-09-01

    We tested whether a high spinal anesthesia may alter the susceptibility to the soporific effects of sedatives. Twenty ASA grade I and II women undergoing elective abdominal hysterectomy were randomly allocated into two groups. Patients in Group I were given a subarachnoid injection of 12 mg hyperbaric tetracaine and those patients who after 10 min had a sensory level of T4-6 (10 patients) were included in the study. Ten additional patients (Group II) received no spinal injection. Induction of anesthesia was performed on all patients by injecting 1 mg of midazolam intravenously every 30 s until the patient failed to respond to three repeated commands to squeeze the anesthetist's hand. This was considered the induction dose or end-point for the purposes of the study. Patients were then given a neuromuscular blocker, ventilated with oxygen, nitrous oxide, and a volatile anesthetic, tracheally intubated, and maintained under general anesthesia for the remainder of the operation. The dose of midazolam administered to the point of patient failure to respond to command was 7.6 +/- 0.72 mg SEM for Group I and 14.7 +/- 1.16 mg SEM for Group II, (P < 0.0001). These results support the conclusion that patients having a high spinal anesthetic are more sensitive to the sedative effects of midazolam.

  9. Effect of Oral Midazolam Premedication on Children's Co-operation Before General Anesthesia in Pediatric Dentistry.

    Science.gov (United States)

    Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

    2014-09-01

    Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events.

  10. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

    Science.gov (United States)

    Lightdale, Jenifer R.; Mitchell, Paul D.; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Scharff, Lisa; Fox, Victor L.

    2011-01-01

    Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (n = 17) moved more (median 25% of procedure time versus 8%, P = .03) and required similar low levels of restraint (0.83% versus 0.25%, P = .4) as patients sedated with midazolam/fentanyl (n = 20). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (P = .002). Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress. PMID:21760813

  11. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

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    Jenifer R. Lightdale

    2011-01-01

    Full Text Available Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (=17 moved more (median 25% of procedure time versus 8%, =.03 and required similar low levels of restraint (0.83% versus 0.25%, =.4 as patients sedated with midazolam/fentanyl (=20. Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (=.002. Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress.

  12. Evaluation of 6 years use of sedation with midazolam for dental treatment

    DEFF Research Database (Denmark)

    Østergaard, Birthe; Haukali, Gro; Poulsen, Sven

      Abstract: Titel: Evaluering af seks års brug af midazolam til sedering ved tandbehandling. B. Høgsbro Østergaard 1,2 , G. Haukali 1,2, S. Poulsen 2 . 1 Tandplejen Århus, 2 Afd. for Samfundsodontologi og Pædodonti, Århus Tandlægeskole, Århus Universitet. Mål: At evaluere midazolamsedering til......-psykologisk metode eller ved lattergassedering blev udført under anvendelse af peroral sedering med Dormicum® (midazolam). : 233 tandbehandlinger på 114 børn i alderen 1-15 år med kooperationsproblemer som ikke kunne løses ved sædvanlig pædagogisk-psykologisk metode eller ved lattergassedering blev udført under...... anvendelse af peroral sedering med Dormicum® (midazolam). Metode: Alle børnene blev kategoriseret som ASA I eller ASA II. Omkring halvdelen af børnene var mellem 4 og 6 år. Medicinen som blev brugt var midazolamvædske med en koncentration på 5 mg/ml. Dosering var 0,5 mg /kg med en maximum dosis på 12,5 mg...

  13. How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

    Science.gov (United States)

    Jin, Eun Hyo; Hong, Kyoung Sup; Lee, Young; Seo, Ji Yeon; Choi, Ji Min; Chun, Jaeyoung; Kim, Sang Gyun; Kim, Joo Sung; Jung, Hyun Chae

    2017-02-14

    To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it. We prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction. The study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group. Midazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

  14. Midazolam: uma nova alternativa para sedação em odontopediatria = Midazolam: a new alternative to sedation in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Duque, Cristiane

    2005-01-01

    Full Text Available Na prática clínica, existem muitas crianças imaturas e ansiosas ou pacientes com comprometimento físico e/ou mental que não cooperam durante o tratamento odontológico. A sedação pré-operatória é uma das alternativas que facilitam o manejo desses pacientes. O midazolam é um benzodiazepínico que pode ser indicado para crianças, como pré-medicação em procedimentos de curta duração. Isso porque apresenta propriedades hipnóticas e sedativas, além de ser absorvido e eliminado rapidamente pelo organismo. Dessa forma, o objetivo deste estudo é avaliar, por meio de uma revisão de literatura, a efetividade do midazolam, administrado por via oral e intranasal, como agente sedativo para crianças não cooperadoras submetidas a tratamento odontológico

  15. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years' experience at a district general hospital.

    Science.gov (United States)

    Williams, T J; Bowie, P E

    1999-05-01

    Patients may find bronchoscopy without sedation unpleasant. There is some evidence that patient satisfaction correlates with amnesia for the procedure. For several years we have used doses of midazolam sufficient to put patients lightly asleep hoping to produce complete amnesia. We looked at practical aspects of this technique over a 2-year period. We studied 337 consecutive patients. They were 219 men and 118 women of mean age 63 +/- 12.4 (SD). Sixty-seven patients were aged 75 years or over and the eldest was 86. Sixty-three patients were already hospital inpatients but the remainder were seen as day cases. Midazolam was given by slow i.v. injection over several minutes until the patient was judged to be lightly asleep. Patients were given supplemental oxygen (3 l min-1) and monitored by ECG and pulse oximetry. A note was made of the time at which they awakened, defined as when nursing staff felt the patients were awake enough to have a cup of tea and toast. Patients were asked if they had any memory of the procedure both on awakening and when seen a few days later to discuss the results. The procedures were carried out in a well-staffed Day Case Unit with a recovery area. The mean dose of midazolam used was 10.8 mg (mean +/- SD = 0.16 +/- 0.095 mg kg-1). The midazolam was given over a median of 4 min (range 1-15 min). Patients took 59 +/- 45 min (mean +/- SD) to wake up. Twenty-eight patients were given flumazanil to reverse the sedation (11 for concern over bleeding following biopsies, three for desaturation during and three after procedure, four as they were frail, two as they were restless, two as they were hypotensive after procedure and three for miscellaneous reasons). Only nine patients could remember any part of the procedure. Incremental doses of midazolam given slowly until patients are lightly asleep almost invariably produce complete amnesia for bronchoscopy. This is a safe technique but patients need careful monitoring and may require reversal of

  16. CO - INDUCTION : A COMPARATIVE STUDY OF MIDAZOLAM KETAMINE AND PROPOFOL AS COINDUCING AGENTS TO PROPOFOL

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    Jyothi

    2015-07-01

    Full Text Available INTRODUCTION : “Co - induction” refers to the administration of a small dose of a sedative or anaesthetic agent prior to the induction of anesthesia, with the aim of achieving more specific ‘target’ responses, while minimizing side effects. Although Propofol is a very po pular IV induction agent, it causes various adverse effects like hypotension and apnoea and it is expensive. So the present study was designed to find whether the concept of co - induction can be used to overcome the above mentioned short comings of Propofol induction. AIM: To compare the effectiveness and evaluate the use of midazolam, ketamine and propofol as co - inducing agents to propofol for general anesthesia. DESIGN : A Prospective Randomized Double blind study was planned. METHOD S : 100 adult patients of ASA grade 1 and 2 aged between 18 – 50 yrs. undergoing elective general, orthopedic or gynecological surgeries under general anesthesia were randomly allocated into four groups of 25 each: Group SP: received normal saline 3 ml IV as co - induction agent. Grou p MP: received inj. Midazolam 0.03mg \\ kg IV Group KP: received inj. Ketamine 0.3mg \\ kg IV . Group PP: received inj. Propofol 0.4mg \\ kg IV (auto - co - induction . All patients received inj. Pentazocine 0.3 mg \\ kg IV followed by blinded pretreatment with either sali ne 3ml IV, (group SP - control, inj.Midazolam.0.03mg \\ kg IV (group M, Inj. Ketamine 0.3mg \\ kg IV (group KP or inj. Propofol 0.4mg \\ kg IV (group PP. Two min later induction was done with inj Propofol until loss of verbal contact or resistance to placement of facemask. Total induction dose of Propofol, associated haemodynamic parameters (HR, MAP at 1min interval for five min after induction and occurrence of significant apnoea (>20 sec or Spo2 < 90% were recorded. The obtained data was analyzed using Chi - squa re test and Students “t” test. RESULTS & CONCLUSION : The mean induction dose of propofol was 1.31mg \\ kg, 1.39mg

  17. Efficacy and safety of non-intravenous midazolam for the treatment of status epilepticus in children: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2016-02-01

    Full Text Available Objective To evaluate the clinical efficacy and safety of non-intravenous midazolam for treating status epilepticus (SE in children.  Methods Taking midazolam, status epilepticus and children both in Chinese and English as search terms, retrieve in databases such as PubMed, ScienceDirect, China National Knowledge Infrastructure (CNKI, VIP and Wanfang Data, assisted by manual searching and Google Scholar, in order to collect randomized controlled trials (RCTs about non-intravenous midazolam for treating SE in children from January 2000 to January 2015. Jadad Scale was used to evaluate the quality of literatures. Meta-analysis was performed by using RevMan 5.3 software. Results There were a total of 258 records after preliminary searching, and 6 RCTs involving 766 episodes were finally included after excluding duplicate ones and those which did not meet the inclusion criteria. The results were as follows: 1 midazolam via intranasal administration was as effective as intravenous diazepam in achieving seizure control in children (RD = -0.070, 95%CI: -0.200—0.060, P = 0.290. However, non-intravenous (intranasal or buccal midazolam showed better effects on seizure control than rectal diazepam (RD = 0.170, 95% CI: 0.030—0.320; P = 0.020. 2 The mean time from arrival at hospital to cessation was not significantly different between intranasal midazolam and intravenous diazepam (SMD = -1.570, 95%CI: -3.280—0.140; P = 0.070. 3 There was no statistical difference between intranasal midazolam and intravenous diazepam for the time from giving drug to cessation (SMD = 0.240, 95%CI: -0.110—0.590; P = 0.170. 4 There was no statistical difference on the occurrence rate of adverse drug reactions between non-intravenous midazolam and intravenous or non-intravenous diazepam (RD = -0.010, 95% CI: -0.030—0.200; P = 0.500.  Conclusions Non-intravenous midazolam is safe and effective in the treatment for status epilepticus in children. However, the

  18. Comparing the Effect of Intravenous Midazolam with Rectal Sodium Valproate in Controlling of Children with Refractory Status Epilepticus

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    T Mahmoudian

    2006-01-01

    Full Text Available Background: Refractory status epilepticus usually defined as a seizure lasting at least 60 minutes which is uncontrollable by Diazepam, Phenytoin, or Phenobarbital. The aim of this study was to compare the effect of interavenous Midazolam and rectal Sodium valproate in controlling refractory status epilepticus. Methods: In this case-control study; 76 children with (mean age of 37± 20 months with refractory status epilepticus were randomly divided into two groups to receive IV Midazolam and rectal Sodium Valproate. The effect of the two drugs were compared in control of seizure during first 20 minutes of treatment. Results: In 84.2 percent of children treated with IV Midazolam, the seizure was under control within 4.5 ± 0.5 minutes, while in 63 percent of those receiving Sodium Valproate, the seizure was completely controlled within 16.5 ± 0.8 minutes (P < 0.00001. Conclusion: The IV Midazolam was more effective than Sodium valproate, but the latter can be used in hospitals or pediatric emergency wards without ICU for controlling of refractory status epilepticus. Key words: refractory status epilepticus, midazolam, sodium valproate

  19. Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsions in children: a randomized controlled trial.

    Science.gov (United States)

    Talukdar, Bibek; Chakrabarty, Biswaroop

    2009-11-01

    A study was done to examine the efficacy of buccal midazolam in controlling convulsion in children by comparing it with intravenous diazepam, a standard mode of treating convulsions. One hundred and twenty cases presenting with convulsions to emergency were treated randomly with either buccal midazolam (in a dose of 0.2mg/kg) or intravenous diazepam (in a dose of 0.3mg/kg). Partial seizures, generalized tonic, clonic and tonic-clonic convulsions were included irrespective of duration or cause. One episode per child only was included. The frequency of overall control of convulsive episodes within 5 min were 85% and 93.3% in buccal midazolam and intravenous diazepam groups, respectively; the difference was, however, not statistically significant (p=0.142). The mean time needed for controlling the convulsive episodes after administration of the drugs was significantly less with intravenous diazepam (p=diazepam (p=0.004) that is likely to be due to longer time needed for initiating treatment with intravenous diazepam in preparing the injection and establishing an IV line. There was no significant side effect in both the groups. The findings suggest that buccal midazolam can be used as an alternative to intravenous diazepam especially when getting an IV line becomes difficult. In situations where establishing an IV line is a problem, buccal midazolam may be the first choice.

  20. The Effectiveness of Midazolam for Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Ahn, Eun Jin; Kang, Hyun; Choi, Geun Joo; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Choel

    2016-03-01

    Previous randomized controlled trials regarding the effectiveness of perioperative midazolam in preventing postoperative nausea and vomiting (PONV) have produced conflicting results. Consequently, the present systematic review was performed to assess the effect of perioperative administration of midazolam on PONV. The MEDLINE®, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify all randomized controlled trials that investigated the effectiveness of midazolam under general anesthesia. The primary end points were defined as postoperative nausea (PON), postoperative vomiting (POV), and PONV. From 16 studies, 1433 patients were included in the final analysis. Compared with the control group, patients who received midazolam showed a lower overall incidence of PON (risk ratio [RR], 0.51; 95% confidence interval [CI], 0.40-0.65; I = 35%; number needed to treat [NNT] = 6; number of included studies [n] = 11), POV (RR, 0.46; 95% CI, 0.33-0.65; I = 0%; NNT = 8; n = 10), and PONV (RR, 0.45; 95% CI, 0.36-0.57; I = 31%; NNT = 3; n = 7). Perioperative administration of midazolam was effective in preventing PON, POV, and PONV.

  1. The effect of midazolam on the recovery quality, recovery time and the minimum alveolar concentration for extubation in the isoflurane-anesthetized pig.

    Science.gov (United States)

    Kleine, S A; Quandt, J E; Hofmeister, E H; Peroni, J

    2015-04-01

    There are no reported studies evaluating the effect of midazolam on recovery quality, recovery time or minimum alveolar concentration (MAC) at which extubation occurs (MAC extubation). Our hypotheses were that midazolam administered prior to recovery would decrease MAC extubation, prolong recovery time but provide a smoother recovery. Sixteen Yorkshire pigs were anesthetized with isoflurane for approximately 5 h. The end-tidal isoflurane concentration was then stabilized at 1.4% for 20 min. Pigs were randomly assigned to receive midazolam or saline. The vaporizer was decreased by 10% every 10 min until extubation. Pigs were declared awake by a blinded observer and were assigned a recovery score by the same observer. Mean MAC extubation was not significantly different for pigs receiving saline prior to recovery compared with those pigs receiving midazolam. The overall mean MAC extubation for both groups was 0.6 ± 0.4 vol%. Time to extubation was not significantly longer with midazolam (124 ± 36 min) compared with the saline group (96 ± 61 min; P = 0.09). Recovery score was not significantly different between groups (midazolam, 0.86 ± 1.1; saline 0.5 ± 0.5; P = 0.26). In conclusion, midazolam did not affect MAC extubation. There was no advantage of administering midazolam in the recovery period when performing step-down titration of isoflurane anesthesia.

  2. Systemic or Intra-Amygdala Injection of a Benzodiazepine (Midazolam) Impairs Extinction but Spares Re-Extinction of Conditioned Fear Responses

    Science.gov (United States)

    Hart, Genevra; Harris, Justin A.; Westbrook, R. Frederick

    2009-01-01

    Rats were subjected to one or two cycles of fear conditioning and extinction, injected with a benzodiazepine, midazolam, before the first or second extinction, and tested for long-term inhibition of fear responses (freezing). In Experiment 1, inhibition of context-conditioned fear was spared when midazolam was injected before the second…

  3. Systemic or Intra-Amygdala Injection of a Benzodiazepine (Midazolam) Impairs Extinction but Spares Re-Extinction of Conditioned Fear Responses

    Science.gov (United States)

    Hart, Genevra; Harris, Justin A.; Westbrook, R. Frederick

    2009-01-01

    Rats were subjected to one or two cycles of fear conditioning and extinction, injected with a benzodiazepine, midazolam, before the first or second extinction, and tested for long-term inhibition of fear responses (freezing). In Experiment 1, inhibition of context-conditioned fear was spared when midazolam was injected before the second…

  4. An ultra-sensitive LC-MS/MS method to determine midazolam levels in human plasma: development, validation and application to a clinical study.

    Science.gov (United States)

    Chen, Mu; Lu, Wenzhe; Lu, Yang; Kang, Lijuan; Zhao, Harry; Lin, Zhongping John; Wang, Weimin; Fraier, Daniela; Ottaviani, Giorgio

    2017-02-01

    Midazolam is a commonly used marker substrate for the in vivo assessment of CYP3A activity. Reliable pharmacokinetic assessment at sub-pharmacological doses of midazolam requires an ultra-sensitive analytical method. A new, ultra-sensitive LC-MS/MS method for the determination of midazolam in human plasma using SPE was developed and fully validated. The lowest limit of quantitation is 0.1 pg/ml with a sample volume of 500 μl. The following parameters were validated: sensitivity, assay accuracy and precision, linearity, selectivity, and stability of midazolam at pertinent analytical and storage conditions. The validated method was utilized successfully for the sample assay during a midazolam microdosing study for the evaluation of CYP3A4 activity of a clinical candidate.

  5. Estudo comparativo de midazolam com cetamina S(+ versus midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina

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    Almeida Vonaldo Torres de

    2006-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Avaliar a efetividade, a analgesia pós-operatória e o grau de satisfação e recomendação das pacientes submetidas à aspiração manual intra-uterina por meio da comparação de duas técnicas anestésicas. MÉTODO: Foram estudadas, prospectivamente, 80 pacientes distribuídas aleatoriamente em dois grupos. Todas receberam midazolam, por via venosa. Em seguida, o Grupo MC recebeu cetamina S(+ por via venosa e o Grupo MP, bloqueio paracervical uterino. Na sala de cirurgia a eficácia da técnica foi avaliada por três observadores (o pesquisador, o obstetra e o residente de obstetrícia e, após uma hora, foi avaliada por um observador que desconhecia a técnica realizada, a analgesia pós-operatória, os graus de satisfação de recomendação da paciente mediante escala verbal. RESULTADOS: As técnicas mostraram-se eficientes em 95% das pacientes do Grupo MC e 76,7% das pacientes do Grupo MP (p = 0,04. Entre as pacientes do Grupo MC, 67% não apresentaram dor após uma hora, enquanto no grupo MP a porcentagem de pacientes sem dor foi de 33,3% (p < 0,01 e um risco relativo = 2. Ambos os grupos tiveram 90% de satisfação e de recomendação da técnica. CONCLUSÕES: Neste estudo concluiu-se que a anestesia com midazolam e cetamina S(+ foi superior à associação de midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina, tanto com relação à eficácia quanto à analgesia pós-operatória, sob o ponto de vista dos observadores. Na opinião das pacientes o índice de satisfação foi alto com as duas técnicas.

  6. A comparison of the metabolism of midazolam in C57BL/6J and hepatic reductase null (HRN) mice.

    Science.gov (United States)

    Grimsley, Aidan; Foster, Alison; Gallagher, Richard; Hutchison, Michael; Lundqvist, Anders; Pickup, Kathryn; Wilson, Ian D; Samuelsson, Kristin

    2014-12-15

    The hepatic cytochrome P450 reductase null (HRN) mouse, which has no functional hepatic Cyp P450s, may represent a useful model for examining extra-hepatic P450-related oxidative metabolism. Here the pharmacokinetics and metabolic fate of midazolam, a drug known to undergo such extra-hepatic metabolism, have been investigated in the HRN mouse and compared with a phenotypically normal strain (C57BL/6J). In addition, the effects of co-administration of the pan-P450 inhibitor 1'-aminobenzotriazole (ABT) on the metabolic profile have been compared in both strains. Significant pharmacokinetic differences for midazolam were observed between the two strains of mice with the HRN mice showing lower circulating concentrations of 1'-hydroxymidazolam but higher concentrations of 1'-hydroxymidazolam-O-glucuronide. A significant increase in midazolam exposure was seen upon ABT exposure for both strains of mice, but no differences in the area under the concentration time curves (AUC) for the monitored metabolites were observed. Although oxidative metabolism of midazolam was not abolished, significant decreases in 1'-hydroxymidazolam formation ratios were observed for both strains of mice exposed to ABT. Metabolite profiling of blood and bile showed a number of qualitative and quantitative differences between HRN and normal mice. These differences in midazolam metabolism between the two strains of mice clearly demonstrate the role that liver P450 enzymes play in the murine metabolism of midazolam. The fate of the compound in the HRN mice shows the importance of extrahepatic metabolism and also showed that these mice appear to be more capable of forming circulating phase II glucuronides than the normal strain.

  7. Comparison of dexmedetomidine, midazolam, and propofol as an optimal sedative for upper gastrointestinal endoscopy: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Sumanth Samson

    2014-01-01

    Full Text Available Context: Midazolam and propofol are effective sedatives for use in upper gastrointestinal endoscopy (UGIE; however, their utility is limited when used alone. In this regard, dexmedetomidine seems to be a promising sedative. Aims: The aim was to compare the hemodynamic effects and sedation efficacy of these drugs in patients undergoing elective diagnostic UGIE. Settings and Design: Randomized control double-blind study was conducted at a teaching hospital. Subjects and Methods: Patients belonging to ASA Grade I or II, undergoing diagnostic elective UGIE were enrolled in the study and randomized into three groups; Group I received midazolam infusion, Group II received propofol infusion and Group III received dexmedetomidine infusion. Hemodynamic parameters and adverse events were recorded during the procedure (intra-operative period [IOP]. Both patient and endoscopist satisfaction were rated on visual analog scale (0 = no pain/least difficulty to 10 = worst pain/maximum difficulty. Recovery was recorded as time to achieve modified Aldrete score of 10/10. Statistical Analysis: Parametric test analysis of variance was applied to compare the means of three groups of continuous data. Results: Ninety patients were analyzed. Mean arterial pressure was significantly lower in the propofol group at IOP 2 , IOP 4 , IOP 8 , and IOP 10 compared with dexmedetomidine and midazolam group. The endoscopist satisfaction level was significantly higher in dexmedetomidine group as compared to propofol and midazolam (60%, 56.7%, 13.3%; P < 0.001. Significantly faster recovery was observed in dexmedetomidine group compared to midazolam and propofol group (7.7 ± 3.9, 18.3 ± 3.8, 12.7 ± 2.9 min; P = 0.001. Conclusions: Use of dexmedetomidine was associated with greater hemodynamic stability and faster recovery when compared to propofol and midazolam.

  8. The effects of diazepam or midazolam on the dose of propofol required to induce anaesthesia in cats.

    Science.gov (United States)

    Robinson, Rebecca; Borer-Weir, Kate

    2015-09-01

    Assess effects of benzodiazepine administration on the propofol dose required to induce anaesthesia in healthy cats, investigate differences between midazolam and diazepam, and determine an optimal benzodiazepine dose for co-induction. Prospective, randomised, blinded, placebo-controlled clinical trial. Ninety client-owned cats (ASA I and II) with a median (interquartile range) body mass of 4.0 (3.4-4.9) kg. All cats received 0.01 mg kg(-1) acepromazine and 0.2 mg kg(-1) methadone intravenously (IV). Fifteen minutes later, sedation was scored on a scale of 1-5, with 5 indicating greatest sedation. Propofol, 2 mg kg(-1) , administered IV, was followed by either midazolam or diazepam at 0.2, 0.3, 0.4 or 0.5 mg kg(-1) or saline 0.1 mL kg(-1) . Further propofol was administered until endotracheal intubation was possible. Patient signalment, sedation score, propofol dosage and adverse reactions were recorded. Midazolam and diazepam (all doses) significantly reduced the propofol dose required compared with saline (p midazolam and diazepam in propofol dose reduction (p = 0.488). All individual doses of midazolam reduced propofol requirement compared with saline (0.2 mg kg(-1) , p = 0.028; 0.3 mg kg(-1) , p = 0.006; 0.4 mg kg(-1) , p Midazolam (0.2-0.5 mg kg(-1) ) and diazepam (0.3-0.5 mg kg(-1) ) administered IV after 2 mg kg(-1) propofol significantly reduced the propofol dose required for tracheal intubation. © 2015 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  9. Does Routine Midazolam Administration Prior to Nasogastric Tube Insertion in the Emergency Department Decrease Patients' Pain? (A Pilot Study).

    Science.gov (United States)

    Manning, Chelsea Taylor; Buinewicz, Jacob Dillon; Sewatsky, Thomas Patrick; Zgonis, Evangelia; Gutierrez, Kathy; O'Keefe, Michael F; Freeman, Kalev

    2016-07-01

    Patients report pain and discomfort with nasogastric tube (NGT) intubation. We tested the hypothesis that premedication with midazolam alleviates pain during NGT placement in the emergency department (ED) by > 13 on a 100-mm visual analog scale (VAS). We performed a double-blind randomized controlled pilot study, assigning ED patients requiring NGT placement to midazolam or placebo. All patients received intranasal cophenylcaine; additionally, they received an intravenous (IV) dose of the study drug, either 2 mg of IV midazolam or saline control. Nurses placed NGTs while observed by research staff, who then interviewed subjects to determine the primary outcome of pain using a VAS. Additional data collected from patients and their nurses included discomfort during the procedure, difficulty of tube insertion, and complications. We enrolled 23 eligible patients and obtained complete data in all: 10 midazolam and 13 controls. We found a significant reduction in mean pain VAS score of -31 (95% confidence interval = -53 to -9 mm) with 2 mg of midazolam (mean ± SD = 52 ± 30 mm), compared to placebo (mean ± SD = 21 ± 18 mm), more than double the effect size considered clinically relevant. Treatment did not impact ease of placement and there were no serious adverse effects. Premedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation. © 2016 by the Society for Academic Emergency Medicine.

  10. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit.

    Science.gov (United States)

    Lu, Xing; Li, Jun; Li, Tong; Zhang, Jie; Li, Zhi-Bo; Gao, Xin-Jing; Xu, Lei

    2016-04-01

    To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU. This randomized, prospective study was conducted in Tianjin Third Central Hospital, China. Using a sealed-envelope method, the patients were randomly divided into 2 groups (40 patients per group). Each patient of group A received an initial loading dose of midazolam at 0.3-3mg/kg·h 24 h before extubation, followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation. Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation. The dose of sedation was regulated according to RASS sedative scores maintaining in the range of -2-1. All patients were continuously monitored for 60 min after extubation. During the course, heart rate (HR), mean artery pressure (MAP), extubation time, adverse reactions, ICU stay, and hospital stay were observed and recorded continuously at the following time points: 24 h before extubation (T1), 12 h before extubation (T2), extubation (T3), 30 min after extubation (T4), 60 min after extubation (T5). Both groups reached the goal of sedation needed for ICU patients. Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam, reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)), respectively (p= 0.017). There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam. In the group A, HR was not significantly increased after extubation; however, in the group B, HR was significantly increased compared with the preextubation values (p Midazolam sequential with dexmedetomidine can reach the goal of sedation for ICU agitated patients, meanwhile it can maintain the respiratory and circulation parameters and reduce adverse reactions.

  11. Rate of change of blood concentrations is a major determinant of the pharmacodynamics of midazolam in rats.

    Science.gov (United States)

    Cleton, A; Mazee, D; Voskuyl, R A; Danhof, M

    1999-05-01

    The objective of this investigation was to characterize quantitatively the influence of the rate of increase in blood concentrations on the pharmacodynamics of midazolam in rats. The pharmacodynamics of midazolam were quantified by an integrated pharmacokinetic-pharmacodynamic modelling approach. Using a computer controlled infusion technique, a linear increase in blood concentrations up to 80 ng ml(-1) was obtained over different time intervals of 16 h, resulting in rates of rise of the blood concentrations of respectively, 1.25, 1.00, 0.87, 0.46, 0.34 and 0.20 ng ml(-1) min(-1). In one group of rats the midazolam concentration was immediately brought to 80 ng ml(-1) and maintained at that level for 4 h. Immediately after the pretreatment an intravenous bolus dose was given to determine the time course of the EEG effect in conjunction with the decline of midazolam concentrations. The increase in beta activity (11.5-30 Hz) of the EEG was used as pharmacodynamic endpoint. For each individual animal the relationship between blood concentration and the EEG effect could be described by the sigmoidal Emax model. After placebo, the values of the pharmacodynamic parameter estimates were Emax = 82+/-5 microV, EC50,u = 6.4+/-0.8 ng ml(-1) and Hill factor = 1.4+/-0.1. A bell-shaped relationship between the rate of change of midazolam concentration and the value of EC50,u was observed with a maximum of 21+/-5.0 ng ml(-1) at a rate of change of 0.46 ng ml(-1) min(-1); lower values of EC50,u were observed at both higher and lower rates. The findings of this study show that the rate of change in plasma concentrations is an important determinant of the pharmacodynamics of midazolam in rats.

  12. Comparison of midazolam and propofol for sedation in pediatric diagnostic imaging studies.

    Science.gov (United States)

    Sebe, Ahmet; Yilmaz, Hayri Levent; Koseoglu, Zikret; Ay, Mehmet Oguzhan; Gulen, Muge

    2014-05-01

    This study aims to compare the efficacy of propofol and midazolam in terms of adverse effect potentials and to determine the appropriate strategy for pediatric procedural sedation. A total of 200 pediatric patients (aged propofol (Group 1: IV bolus dose of 2 mg/kg during a 2-minute period, IV maintenance dose of 100 mcg/kg/min) or midazolam (Group 2: IV bolus dose of 0.15 mg/kg during a period of 2 to 3 minutes) to achieve sedation. Demographic data, body weight, and clinical status of the patients were evaluated and recorded. The vital signs and sedation levels (ie, Ramsay sedation scale scores) were evaluated and recorded, as well as the complications detected and medications administered in 10-minute intervals throughout the sedation procedure. Findings between the study arms were compared. Arterial blood pressures decreased significantly in both groups (P = 0.001). The patients in Group 1 experienced a greater difference in diastolic blood pressure (P = 0.001) than those in Group 2. Sedation scores in Group 1 were more favorable (P = 0.014) and reached the appropriate sedation level in a shorter time than those in Group 2 (P = 0.010). Likewise, recovery time of patients was shorter in Group 1 than in Group 2 (P = 0.010). Hypoxia was found to be more common in the propofol group, but the difference was not significant (P = 0.333). Propofol seems to be more effective, achieve the appropriate sedation level more quickly, and provide a faster onset of sedation than midazolam in pediatric procedural sedation and analgesia. Propofol is preferred for imaging studies (computed tomography and magnetic resonance imaging) to reduce the occurrence of undesired motion artefacts. Although both drugs are safe to use for sedation before pediatric imaging procedures, propofol is preferred with appropriate preparation.

  13. Propofol versus midazolam/ketamine for procedural sedation in pediatric oncology.

    Science.gov (United States)

    Gottschling, Sven; Meyer, Sascha; Krenn, Thomas; Reinhard, Harald; Lothschuetz, Daniela; Nunold, Holger; Graf, Norbert

    2005-09-01

    Different pharmacologic agents have been used for sedation in children undergoing invasive procedures. The authors prospectively compared the efficacy, the occurrence of adverse effects, cardiovascular parameters, oxygen saturation and induction, and recovery time in propofol with or without morphine versus midazolam/ketamine sedation for procedural sedation in children with malignancies and hematologic disorders. Fifty children received either propofol with or without morphine or ketamine/midazolam sedation for invasive procedures. Intravenous sedation consisted of 0.1 mg midazolam/kg and 1.0 mg ketamine/kg or 2 mg propofol/kg with or without 0.1 mg morphine/kg. Incremental dosages of ketamine or propofol were given, if necessary, to achieve or to maintain adequate sedation levels. Systolic and diastolic blood pressure, heart rate, oxygen saturation, time to induce sedation, recovery time, and adverse effects were recorded. All invasive procedures were successfully completed, with satisfactory sedation levels in all 25 patients in the propofol group and 23 of the 25 patients in the ketamine group. In 14 of the 25 procedures in the propofol group and 4 of the 25 procedures in the ketamine group, sedation was associated with side effects, the most common being oxygen desaturation. There was a significant increase in diastolic blood pressure after ketamine medication and a significant decrease in systolic and diastolic blood pressure and heart rate in the propofol group. Induction and recovery times in the propofol group were significantly shorter. Both regimens for procedural sedation are efficacious in achieving satisfactory sedation levels for invasive procedures. Propofol offers a quicker onset of sedation and a faster, smoother recovery but is associated with a higher rate of side effects. Considering the substantial rate of adverse effects, these procedural sedations should be performed only by physicians trained in advanced airway management and life support.

  14. Efficacy and safety of midazolam and ketamine in paediatric upper endoscopy.

    Science.gov (United States)

    Basturk, Ahmet; Artan, Reha; Yılmaz, Aygen

    2017-06-01

    Upper endoscopy can be successfully carried out in children under deep sedation and anaesthesia. However, the best method of upper endoscopy for children who require gastrointestinal intervention has yet to be defined. The aim of this study is to investigate the efficacy and safety of the sedation induced by intravenous midazolam and ketamine during upper endoscopy in children. This study included patients ages 3-18years who had undergone upper endoscopy. All subjects received IV midazolam and ketamine. During the intervention, hypoxia, tachycardia, bradycardia, hypertension, and hypotension were recorded. After the intervention, euphoria, dysphoria, vertigo, visual problems (such as diplopia and nystagmus), and emergencies (such as arrhythmia, convulsion, and hallucination), among other findings, were recorded. Older children who were capable of expressing themselves were questioned to help determine these conditions. The mean age of the study group was was 11.9±3.42years; 54% of the patients were females, and 46% were males. During the upper endoscopy, hypoxia occurred in 9% of patients, mild hypertension in 14%, hypotension in 5%, tachycardia in 23%, bradycardia in 8%, and flushing-urticaria in 2%. After the upper endoscopy, one of the most common complications was sore throat, which occurred in 24% of patients. Vomiting was observed in 14% of patients, dizziness in 24%, diplopia in 27%, euphoria in 3% (5 patients), dysphoria in 4%, and hallucination in 4%. Of the total patients, 4% required oxygen supply with a face mask. The results of our study showed that the use of IV midazolam and ketamine during upper endoscopy in children was safe and effective. Copyright © 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

  15. STUDY OF ORAL MIDAZOLAM AS A PREANAESTHTIC MEDICATION FOR ELECTIVE SURGERY IN PAEDIATRIC PATIENTS

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    Jaya

    2014-12-01

    Full Text Available : BACKGROUND: Pre anaesthetic medication is a real challenge specially in cases of paediatric age group. A good quality oral preanaesthetic must fulfill criteria like easily application, rapid absorption, short duration of action and have minimal side effect. Present study carried out with objective of evaluation of oral Midazolam as a pre-anaesthetic in elective surgical cases in paediatric age group. METHODS: Paediatric cases for elective surgery were included for receiving oral midazolam (0.5/kg pre anaesthetic medication in prospective observational study. Total 50 cases from age group (01-10 yrs, weight (13-23kg, ASA grading I & II, normo-tensive patients were selected. Evaluation of drug was assessed with a scale from 1-4 which includes sedation, separation from parent, and child behaviour at induction. Data analyzed with percentage and mean standard deviation of the scale score. RESULTS: Sedation score mean after pre medication was 2.76+ 0.58. Child behaviour at the time of separation from parents score mean was 2.96+ 0.44. Mean score of behaviour of child during induction was 2.80+0.49. 70% of the cases achieved sedation, 86 % of the cases achieved separation from parents while 76% of the cases had more than 2 score of child behaviour at the time of induction. CONCLUSION: Oral midazolam as a preanaesthetic medication in children allay the anxiety & facilitate separation of children from their parents when they enter surgical unit. These can be overcome by lower degree of sedation in our study.

  16. Comparison of effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations in transurethral procedures.

    Science.gov (United States)

    Kose, Emine Arzu; Honca, Mehtap; Yılmaz, Erdal; Batislam, Ertan; Apan, Alpaslan

    2012-06-01

    To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P Aldrete scores were greater in group K than group M. Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Effects of implant surgery on blood pressure and heart rate during sedation with propofol and midazolam.

    Science.gov (United States)

    Ueno, Daisuke; Sato, Junichi; Nejima, Jun; Maruyama, Keisuke; Kobayashi, Mariko; Iketani, Toshikazu; Sekiguchi, Rei; Kawahara, Hiroshi

    2012-01-01

    Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam. Medical records of 252 patients who underwent implant surgery were retrospectively analyzed. Patients were classified into four groups according to their age (in years) and hypertension status: A=≤64, no hypertension; B=≥65, no hypertension; C=≤64, hypertension; or D=≥65, hypertension. Hypertensive patients were further characterized by their antihypertensive medications: E=calcium channel blockers (CCBs), F=angiotensin II receptor blockers (ARBs), G=CCBs+ARBs, or H=no medication. IV sedation was administered in two stages. After midazolam injection to prevent angialgia, propofol was infused at the rate of 4 mg/kg/h, followed by a dose reduction. Systolic and diastolic BP and heart rate were recorded before, during, and after surgery. Systolic BP increased significantly after patients were draped in groups A, C, and D, with group D showing the most pronounced increase. Sedatives decreased BP in all groups. Diastolic BP in group F decreased significantly compared to group H after induction and before infiltration of local anesthetic. After infiltration, systolic BP decreased more significantly in group G than in group H. Intraoperative hypotension was observed in 25% of patients. The incidence of intraoperative hypertension in group D was markedly higher than in group A (23% vs 4%). IV sedation using midazolam and propofol reduces hypertensive risks during implant surgery. Nevertheless, care must be taken, especially in older hypertensive patients and in hypertensive patients on ARBs or ARBs+CCBs.

  18. Spatial-temporal patterns of electrocorticographic spectral changes during midazolam sedation

    Science.gov (United States)

    Nishida, Masaaki; Zestos, Maria M.; Asano, Eishi

    2015-01-01

    Objective To better understand ‘when’ and ‘where’ wideband electrophysiological signals are altered by sedation. Methods We generated animation movies showing electrocorticography (ECoG) amplitudes at eight spectral frequency bands across 1.0 to 116 Hz, every 0.1 second, on three-dimensional surface images of 10 children who underwent epilepsy surgery. We measured the onset, intensity, and variance of each band amplitude change at given nonepileptic regions separately from those at affected regions. We also determined the presence of differential ECoG changes depending on the brain anatomy. Results Within 20 seconds following injection of midazolam, beta (16–31.5 Hz) and sigma (12–15.5 Hz) activities began to be multifocally augmented with increased variance in amplitude at each site. Beta-sigma augmentation was most prominent within the association neocortex. Augmentation of low-delta activity (1.0–1.5 Hz) was relatively modest and confined to the somatosensory-motor region. Conversely, injection of midazolam induced attenuation of theta (4.0–7.5 Hz) and high-gamma (64–116 Hz) activities. Conclusions Our observations support the notion that augmentation beta-sigma and delta activities reflects cortical deactivation or inactivation, whereas theta and high-gamma activities contribute to maintenance of consciousness. The effects of midazolam on the dynamics of cortical oscillations differed across regions. Significance Sedation, at least partially, reflects a multi-local phenomenon at the cortical level rather than global brain alteration homogeneously driven by the common central control structure. PMID:26613652

  19. Long-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer.

    Science.gov (United States)

    Ramani, S; Karnad, A B

    1996-11-01

    We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory to standard doses of drugs such as lorazepam, diazepam, and haloperidol. We report the use of a subcutaneous infusion of midazolam at home and its effectiveness in control of her delirium after other drugs had failed.

  20. The effect of midazolam on neutrophil mitogen-activated protein kinase.

    LENUS (Irish Health Repository)

    Ghori, Kamran

    2010-06-01

    Neutrophil p38 mitogen-activated protein kinase (MAPK) is a key enzyme in the intracellular signalling pathway that is responsible for many neutrophil functions, which are important in neutrophil-endothelial interaction. The imidazole compounds are inhibitors of this enzyme system. The objectives of this in-vitro investigation were to examine the effect of midazolam on neutrophil p38 MAPK activation (phosphorylation) following in-vitro ischaemia-reperfusion injury, and the expression of adhesion molecule CD11b\\/CD18.

  1. Estudo comparativo dos efeitos do alprazolam e midazolam no controle da ansiedade em implantodontia

    OpenAIRE

    Ana Paula Guerreiro Bentes

    2012-01-01

    Resumo: A sedação mínima deve ser considerada como parte do protocolo farmacológico nas cirurgias implantodônticas, já que os pacientes podem apresentar um grau aumentado de ansiedade, interrompendo o curso da intervenção, entre outras possíveis intercorrências. O objetivo deste trabalho foi avaliar, de forma comparativa, os efeitos do alprazolam e midazolam no controle da ansiedade neste tipo de intervenção. Cinquenta voluntários, ASA I ou ASA II, com indicação para a colocação de implantes ...

  2. EVALUATION OF ORAL MIDAZOLAM AS CONSCIOUS SEDATION FOR PEDIATRIC PATIENTS IN ORAL RESTORATION

    Institute of Scientific and Technical Information of China (English)

    Kuo Wan; Quan Jing; Ji-zhi Zhao

    2006-01-01

    Objective To evaluate the effect of midazolam alone on sedation in young children for dental restorative care.Methods Forty children, aged 5 to 10 years with a mean age of 7.3 years, participated in this study. Twenty-one patients were assigned to intervention group received 0.5 mg/kg of oral midazolam 20 minutes prior to the beginning of dental treatment, and 19 patients in control group received placebo liquid 20 minutes before treatment. All patients received painless local anesthetic injection and were restrained with children's board and bands. Blood pressure (BP),heart rate (HR), oxygen saturation, treatment compliance scores of the Ramsay scale, the Briekopf and Buttner scale,Frankl scale, and the Houpt scale were recorded. Each procedure was taped and all the data were evaluated every 5 minutes by an anesthetist or experienced dentist who was unaware of the drug given to the child.Results HR in intervention group (82.5±5.1bpm) was much lower than that in control group ( 95.2±8.9 bpm; F=31.20, P<0.001). Intervention group had a significantly lower systolic BP level (94.8 ± 5.6 mm Hg) than control group (98.5±5.5 mm Hg; F=4.34, P=0.04), but the diastolic BP (63.0±3.5 mm Hg) was not significantly lower than control group (65.5±4.8 mm Hg; F=3.31, P=0.07 ). Children in intervention group showed more compliance. The patients' scores of the Ramsay scale, Briekopf and Buttner scale, Frankl scale, and Houpt scale in intervention group (1.37±0.96, 1.37±0.83, 1.32±0.67, and 2.32±1.49, respectively) were significantly lower than those in control group (3.71±1.23, 2.71±0.96, 2.71±0.90, and 4.71±1.19; F=44.66, 22.36,30.39, and 31.88, respectively, all P<0.001 ).Conclusions Oral midazolam alone is safe and produces effective sedation for the dental treatment of young children. Oral midazolam application should be generally preferred because it is more easily accepted by pediatric patients.

  3. Midazolam microdose to determine systemic and pre-systemic metabolic CYP3A activity in humans

    Science.gov (United States)

    Hohmann, Nicolas; Kocheise, Franziska; Carls, Alexandra; Burhenne, Jürgen; Haefeli, Walter E; Mikus, Gerd

    2015-01-01

    Aim We aimed to establish a method to assess systemic and pre-systemic cytochrome P450 (CYP) 3A activity using ineffective microgram doses of midazolam. Methods In an open, one sequence, crossover study, 16 healthy participants received intravenous and oral midazolam at microgram (0.001 mg intravenous and 0.003 mg oral) and regular milligram (1 mg intravenous and 3 mg oral) doses to assess the linearity of plasma and urine pharmacokinetics. Results Dose-normalized AUC and Cmax were 37.1 ng ml−1 h [95% CI 35.5, 40.6] and 39.1 ng ml−1 [95% CI 30.4, 50.2] for the microdose and 39.0 ng ml−1 h [95% CI 36.1, 42.1] and 37.1 ng ml−1 [95% CI 26.9, 51.3] for the milligram dose. CLmet was 253 ml min−1 [95% CI 201, 318] vs. 278 ml min−1 [95% CI 248, 311] for intravenous doses and 1880 ml min−1 [95% CI 1590, 2230] vs. 2050 ml min−1 [95% CI 1720, 2450] for oral doses. Oral bioavailability of a midazolam microdose was 23.4% [95% CI 20.0, 27.3] vs. 20.9% [95% CI 17.1, 25.5] after the regular dose. Hepatic and gut extraction ratios for microgram doses were 0.44 [95% CI 0.39, 0.49] and 0.53 [95% CI 0.45, 0.63] and compared well with those for milligram doses (0.43 [95% CI 0.37, 0.49] and 0.61 [95% CI 0.53, 0.70]). Conclusion The pharmacokinetics of an intravenous midazolam microdose is linear to the applied regular doses and can be used to assess safely systemic CYP3A activity and, in combination with oral microdoses, pre-systemic CYP3A activity. PMID:25588320

  4. Intranasal sufentanil/midazolam versus ketamine/midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double-blind, randomized comparison.

    Science.gov (United States)

    Roelofse, J A; Shipton, E A; de la Harpe, C J; Blignaut, R J

    2004-01-01

    This article details a double-blind, randomized study evaluating the efficacy and safety of intranasal sufentanil and intranasal midazolam (S/M) when compared with intranasal ketamine and intranasal midazolam (K/M) for sedation and analgesia in pediatric patients undergoing dental surgery. Fifty healthy ASA status 1 children aged 5-7 years, weighing 15-20 kg, and having 6 or more teeth extracted, were randomly allocated to 2 groups of 25 patients each (n = 50). In the S/M group, 25 children received intranasal sufentanil 20 microg, and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. In the K/M group, 25 children received intranasal ketamine 5 mg/kg and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. Sevoflurane in nitrous oxide and oxygen was used for induction and maintenance of anesthesia. This study demonstrated the safety and efficacy of both methods with ease of administration, combined with a rapid onset of action. Both groups were equally sedated. A smooth mask induction of anesthesia was experienced in the majority of children. Effective postoperative analgesia for multiple dental extractions was provided. The intranasal administration of drugs for sedation and analgesia has some promising features in preschool children undergoing multiple dental extractions.

  5. Midazolam versus diazepam para tratamento de estado de mal epiléptico em emergência pediátrica = Midazolam versus diazepam for the treatment of status epilepticus in pediatric emergency

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    Portela, Janete de Lourdes

    2011-01-01

    Conclusões: se o acesso intravenoso não estiver disponível, há evidências de que o midazolam por via intramuscular, bucal ou nasal pode ser a alternativa ao diazepam endovenoso ou retal, para tratamento de convulsão em emergência pediátrica

  6. Urinary 6β-Hydroxycortisol/Cortisol Ratio Most Highly Correlates With Midazolam Clearance Under Hepatic CYP3A Inhibition and Induction in Females: A Pharmacometabolomics Approach.

    Science.gov (United States)

    Shin, Kwang-Hee; Ahn, Li Young; Choi, Man Ho; Moon, Ju-Yeon; Lee, Jieon; Jang, In-Jin; Yu, Kyung-Sang; Cho, Joo-Youn

    2016-09-01

    Endogenous metabolites of cytochrome P450 (CYP3A) are useful in predicting drug-drug interactions between in vivo CYP3A inhibitors and inducers for clinical applications of CYP3A substrate drugs. This study aimed to develop predictable markers of the magnitude of hepatic CYP3A induction and inhibition in healthy female subjects using pharmacometabolomics. Twelve female subjects received midazolam during three study phases: 1 mg midazolam (control phase), 1 mg midazolam after pretreatment with 400 mg ketoconazole once daily for 4 days (CYP3A inhibition phase), and 2.5 mg midazolam after pretreatment with 600 mg rifampicin once daily for 10 days (CYP3A induction phase). Throughout the study, blood samples were collected 24 h after midazolam administration and urine samples at 12-h intervals during the 24 h before and after midazolam administration for the analysis of endogenous steroid metabolites. A statistical model was generated to predict midazolam clearance using measurements of endogenous metabolites associated with the inhibition and induction of CYP3A. Mean midazolam clearance decreased to ∼20% of control levels during the inhibition phase and increased more than 2-fold during the induction phase. Of the urine and plasma metabolites measured, the 6β-hydroxycortisol/cortisol ratio was most significantly correlated with midazolam clearance during hepatic CYP3A inhibition and induction. Our results suggest that the urinary 6β-hydroxycortisol/cortisol ratio is the best predictor of hepatic CYP3A activity under both maximal inhibition and maximal induction. Furthermore, the predictive model including 6β-hydroxycortisol/cortisol as a covariate could be applied to predict the magnitude of CYP3A-mediated drug interactions.

  7. The discriminative stimulus effects of midazolam are resistant to modulation by morphine, amphetamine, dizocilpine and γ-butyrolactone in rhesus monkeys

    Science.gov (United States)

    Bai, Xiang; France, Charles P.; Gerak, Lisa R.

    2011-01-01

    Rationale Although abuse of benzodiazepines alone is uncommon, it is high in polydrug abusers, including those who abuse primarily opioids or stimulants. Objectives This study investigated whether drugs that are abused (e.g., amphetamine) or have mechanisms of action similar to abused drugs (e.g., morphine) alter the discriminative stimulus effects of the benzodiazepine midazolam. Methods Three rhesus monkeys discriminated 0.56 mg/kg of midazolam while responding under a fixed ratio 10 schedule of food presentation. Dose-effect curves were determined for midazolam alone and in the presence of morphine (opioid receptor agonist), amphetamine (dopamine receptor indirect agonist), dizocilpine (N-methyl-D-aspartic acid receptor antagonist), or γ-butyrolactone (prodrug of γ-hydroxybutyrate, which acts primarily at GABAB receptors). Results Doses of midazolam larger than 0.32 mg/kg produced ≥80% midazolam-lever responding. When administered alone, morphine, amphetamine, dizocilpine and γ-butyrolactone did not produce midazolam-lever responding, although large doses of each drug eliminated responding; when administered in combination with midazolam, they did not alter the discriminative stimulus effects of midazolam up to doses that markedly decreased response rates. Conclusions The current study demonstrates a lack of modulation of the discriminative stimulus effects of midazolam by morphine, amphetamine, dizocilpine, and γ-butyrolactone. Other effects of benzodiazepines, such as their reinforcing effects, might be altered by these other drugs, or benzodiazepines might modulate the discriminative stimulus or reinforcing effects of the other drugs, which might contribute to the relatively high incidence of benzodiazepine abuse among polydrug abusers. PMID:21503606

  8. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation Sedação com midazolam e hidroxizina por via oral em Odontopediatria: ensaio clínico randomizado, controlado e cruzado

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    Alessandra Rodrigues de Almeida Lima

    2003-09-01

    Full Text Available The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg, or MH - midazolam (0.75 mg/kg plus hydroxyzine (2.0 mg/kg. Vital signs (blood pressure, breathing rate, pulse and oxygen saturation and behavior parameters (consciousness, crying, movement, overall behavior were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg; MH - midazolam (0,75 mg

  9. HPLC法测定大鼠血浆中1'-羟基咪达唑仑及咪达唑仑的浓度%Determination of 1'-hydroxy Midazolam and Midazolam in Rat Plasma by HPLC

    Institute of Scientific and Technical Information of China (English)

    李维亮; 辛华雯; 靳桂明; 苏明威

    2011-01-01

    Objective: To describe a sensitive determination of midazolam and its related metabolite 1' -hydroxy midazolam in rat plasma by high performance liquid chromatography ( HPLC). Method: The plasma sample was mixed with internal standard solution ( diazepam) before the addition of buffer bicarbonate to alkalify the plasma drug,and then vortex-mixed with the solvent (dichlorometh-ane: hexane =3:7,v:v). A Hypersil BDS C18 column (250 mm ×4. 6 mm,5 μm)equipped with a guard column was kept at 40 ℃.The mobile phase consisted of phosphate buffer (0. 02 mol·L-1),acetonitrile and methanol (38:20:42) and was pumped at a constant rate of 1.0 ml · Min-1. The peak was detected using a UV detector set at 230 nm. Result: In this study, the method was validated for the 1' -hydroxy midazolam range of 8. 32-832 ng·ml-1 and the lower limit of quantitation (LLOD) was 8. 32 ng·ml-1.while midazolam ranged from 25 to 2 500 ng·ml-1 and LLOD was 25 ng·ml-1. The intra- and inter-day precisions for 1' -hydroxy midazolam and midazolam were less than 8% ,and the mean recoveries of 1' -hydroxy midazolam and midazolam were 84%-90%. Conclusion: A simple, rapid and repeatable HPLC method is developed for the simultaneous determination of midazolam and its main metabolite 1' -hydroxy midazolam in rat plasma, which is applicable in modeling and description of the possible pharmacological interactions between the medicines and CYP3A enzymes.%目的:建立大鼠血浆中咪达唑仑及其代谢产物1'-羟基咪达唑仑测定的高效液相色谱(HPLC)方法.方法:血浆样品以地西泮为内标,经碳酸盐缓冲液碱化后,由混合有机溶剂(正己烷:二氯甲烷=7∶3,v/v)提取.采用Hypersil BDS C18 (250mm ×4.6 mm,5μm)柱,以KH2 PO4(0.02 mol· L-1)缓冲液-乙腈-甲醇(38∶ 20∶ 42)为流动相,柱温40℃,流速1.0 ml·min-1,于紫外230 nm处检测1'-羟基咪达唑仑及咪达唑仑浓度.结果:在该试验条件下,血浆中1'-羟基咪达唑仑的线性范围为8.32

  10. Rhabdomyolysis after midazolam administration in a cirrhotic patient treated with atorvastatin

    Institute of Scientific and Technical Information of China (English)

    Antonietta; Gigante; Gianluca; Di; Lazzaro; Giraldi; Maria; Ludovica; Gasperini; Biagio; Barbano; Marta; Liberatori; Liborio; Sardo; Francesca; Di; Mario; Antonella; Giorgi; Filippo; Rossi-Fanelli; Antonio; Amoroso

    2014-01-01

    The administration of statins in patients with liver disease is not an absolute contraindication. Hepatotoxicity is a rare and often dose-related event and in the literature there are only a few described cases of fatal rhab-domyolysis in patients with chronic liver disease after statin administration. During treatment with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors,the factors responsible for myopathy may either be related to the patient,or due to interactions with other medications that are metabolic substrates of the same isozymes and therefore able to increase blood statin concentration. The most important side effects consist of increased transaminase levels,abdominal pain or muscle weakness,increased serum levels of creatine kinase and rhabdomyolysis. In this article we report a case of fatal rhabdomyolysis with acute renal failure after gastric endoscopy,where midazolam was used as a sedation agent in a patient with chronic liver disease treated with a high dose of atorvastatin. Therefore,we suggest paying particular attention to the potential risks of associating atorvastatin and midazolam in patients with chronic liver disease who need to undergo gastric endoscopy.

  11. The Efficacy and Safety of Procedural Sedoanalgesia with Midazolam and Ketamine in Pediatric Hematology

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    Sema Aylan Gelen

    2015-12-01

    Full Text Available Objective: The aim of this study is to investigate the efficacy and safety of sedoanalgesia performed outside the operating room by pediatricians trained in advanced airway management and life support. Materials and Methods: Midazolam and ketamine were administered consecutively by intravenous route under cardiorespiratory monitoring for painful procedures of pediatric hematology. Results: A total of 115 patients had 237 sedoanalgesia sessions. Sedation time was 24.02±23.37 s and sedation success was 92.5% (Ramsay scores of ≥5. Patient satisfaction was high. The recovery time was 28.81±14.4 min. Although statistically significant (p<0.01 increases in systolic and diastolic blood pressure, heart rate, and respiratory rate were observed without clinical importance, they improved without any intervention. No severe adverse events were observed. Conclusion: Sedoanalgesia with intravenous midazolam and ketamine for pediatric hematology and oncology patients’ painful minor invasive procedures performed in an optimally equipped setting outside the operating room by pediatricians trained and certificated in advanced airway management and life support is effective and safe.

  12. Assessment the effect of midazolam sedation on hypoxia during upper gastrointestinal endoscopy.

    Science.gov (United States)

    Fakheri, H T; Kiasari, A Z; Taghvaii, T; Hosseini, V; Mohammadpour, R A; Nasrollah, A; Kabirzadeh, A; Shahmohammadi, S

    2010-02-15

    The aim of this study was to evaluate the prevalence of hypoxia related to midazolam sedation during upper gastrointestinal endoscopy. This single blind randomized placebo control clinical trial, carried out on 180 patients who referred to endoscopy clinic at Imam Khomeini Hospital for selective upper gastrointestinal endoscopy from April to July in 2008. Informed consents obtained from all participants. Patients under 18-years-old, obese, previous history of asthma, COPD and cigarette smoking were excluded. Arterial hemoglobin saturation controlled by finger probe pulse oximetry. After pharyngeal lidocaine spray, midazolam was administered intravenously in case group and patients in controlled group received placebo. Demographic characteristics and other variables were recorded in a questionnaire and data analyzed using SPSS software. Gastrointestinal disturbances and epigastric pain were major indications of endoscopies. The most common endoscopic diagnoses were deudonitis, esophagitis or gastroesophagial reflux. No patients had any serious episode of hypoxia and the incidence of mild hypoxia was not significant in both studied group (p = 0.823). There was no significant difference in arterial oxygen saturation recorded by the three endoscopists (p = 0.734). Our data showed that optimal dose of sedation had no hypoxia. So that, we recommend sedative endoscopy in patients without risk factors for hypoxia.

  13. Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation.

    Science.gov (United States)

    Ayuse, T; Inazawa, T; Kurata, S; Okayasu, I; Sakamoto, E; Oi, K; Schneider, H; Schwartz, A R

    2004-09-01

    Sedative doses of anesthetic agents affect upper-airway function. Oral-maxillofacial surgery is frequently performed on sedated patients whose mouths must be as open as possible if the procedures are to be accomplished successfully. We examined upper-airway pressure-flow relationships in closed mouths, mouths opened moderately, and mouths opened maximally to test the hypothesis that mouth-opening compromises upper-airway patency during midazolam sedation. From these relationships, upper-airway critical pressure (Pcrit) and upstream resistance (Rua) were derived. Maximal mouth-opening increased Pcrit to -3.6 +/- 2.9 cm H2O compared with -8.7 +/- 2.8 (p = 0.002) for closed mouths and -7.2 +/- 4.1 (p = 0.038) for mouths opened moderately. In contrast, Rua was similar in all three conditions (18.4 +/- 6.6 vs. 17.7 +/- 7.6 vs. 21.5 +/- 11.6 cm H2O/L/sec). Moreover, maximum mouth-opening produced an inspiratory airflow limitation at atmosphere that was eliminated when nasal pressure was adjusted to 4.3 +/- 2.7 cm H2O. We conclude that maximal mouth-opening increases upper-airway collapsibility, which contributes to upper-airway obstruction at atmosphere during midazolam sedation.

  14. A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery.

    Science.gov (United States)

    Rodrigo, M R; Tong, C K

    1994-03-01

    Thirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist-controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mg for patient and anaesthetist controlled sedation respectively.

  15. Midazolam 12 mg is moderately counteracted by 250 mg caffeine in man.

    Science.gov (United States)

    Mattila, M J; Vainio, P; Nurminen, M L; Vanakoski, J; Seppälä, T

    2000-12-01

    Caffeine (Caf) counteracts various effects of benzodiazepines (BZDs). Since the effects of zolpidem, a short-acting atypical GABA(A)-BZD agonist, were not antagonized by Caf, we studied an interaction between Caf and midazolam (Mid) in healthy volunteers. In Study 1, 108 healthy students divided to 6 parallel groups were given Mid 12 mg (capsule) and Caf 125 and 250 mg (in decaffeinated coffee), alone and in combinations in the double-blind placebo-controlled manner. Objective and subjective tests were done before and at 45 and 90 min after intake. Ranked delta-values (changes from baseline) were analyzed by one-way contrast ANOVA and Scheffe's tests. In Study 2, six healthy subjects took Mid 15 mg (tablet) with and without Caf 300 mg. The dynamic effects were analyzed as in Study 1 and the plasma concentrations were assayed. In Study 1, learn effects after placebo (ad + 15%) were seen for letter cancellation and digit symbol substitution tests. Midazolam alone significantly (p 0.05). In conclusion, in a parallel group study, sedative effects of Mid 12 mg were only moderately antagonized by Caf 250 mg but not by Caf 125 mg. In a cross-over study, a weak interaction was found subjectively but not in objective measures.

  16. Computerized electrocardiogram in agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam

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    Anaemilia N. Diniz

    Full Text Available ABSTRACT: An electrocardiogram is a test that assesses heart electrical activity and is applied more frequently in the veterinary care of wild animals. The present study aimed to define the electrocardiogram pattern of agoutis (Dasyprocta prymnolopha Wagler, 1831 anesthetized with ketamine and midazolam. Eighteen clinically healthy agoutis (D. prymnolopha were used from the Nucleus for Wild Animal Studies and Conservation (NEPAS of the Federal University of Piauí, Brazil. The animals were chemically restrained with 5% ketamine hydrochloride at a dose of 15mg/kg and midazolam at a dose of 1mg/kg by intramuscular injection. Electrocardiogram tests were carried out by a computerized method with the veterinary electrocardiogram [Acquisition Model for Computer (ECG - PC version Windows 95 Brazilian Electronic Technology (TEB consisting of an electronic circuit externally connected to a notebook computer with ECGPC-VET (TEB software installed on the hard disc. In analysing the EKG results, significant differences were observed for QRS complex duration, PR and QT intervals and for R wave millivoltage between the genders; but we observed a significant influence of weight despite the gender. In the present experiment, the anaesthetic protocol was shown to be well tolerated by the agoutis, and no arrhythmias occurred during the time the animals were monitored. The reference values obtained should be used to better understand the cardiac electrophysiology of the species and for its clinical and surgical management.

  17. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.

    Science.gov (United States)

    Mainwaring, C J; Wong, C; Lush, R J; Smith, J G; Singer, C R

    1996-12-01

    This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.

  18. Anesthetic drug midazolam inhibits cardiac human ether-à-go-go-related gene channels: mode of action

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    Vonderlin N

    2015-02-01

    Full Text Available Nadine Vonderlin,1 Fathima Fischer,1 Edgar Zitron,1,2 Claudia Seyler,1 Daniel Scherer,1 Dierk Thomas,1,2 Hugo A Katus,1,2 Eberhard P Scholz1 1Department of Internal Medicine III, University Hospital Heidelberg, 2German Centre for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Heidelberg, Germany Abstract: Midazolam is a short-acting benzodiazepine that is in wide clinical use as an anxiolytic, sedative, hypnotic, and anticonvulsant. Midazolam has been shown to inhibit ion channels, including calcium and potassium channels. So far, the effects of midazolam on cardiac human ether-à-go-go-related gene (hERG channels have not been analyzed. The inhibitory effects of midazolam on heterologously expressed hERG channels were analyzed in Xenopus oocytes using the double-electrode voltage clamp technique. We found that midazolam inhibits hERG channels in a concentration-dependent manner, yielding an IC50 of 170 µM in Xenopus oocytes. When analyzed in a HEK 293 cell line using the patch-clamp technique, the IC50 was 13.6 µM. Midazolam resulted in a small negative shift of the activation curve of hERG channels. However, steady-state inactivation was not significantly affected. We further show that inhibition is state-dependent, occurring within the open and inactivated but not in the closed state. There was no frequency dependence of block. Using the hERG pore mutants F656A and Y652A we provide evidence that midazolam uses a classical binding site within the channel pore. Analyzing the subacute effects of midazolam on hERG channel trafficking, we further found that midazolam does not affect channel surface expression. Taken together, we show that the anesthetic midazolam is a low-affinity inhibitor of cardiac hERG channels without additional effects on channel surface expression. These data add to the current understanding of the pharmacological profile of the anesthetic midazolam. Keywords: midazolam, anesthetics, human ether

  19. A prospective randomised double-blinded study of intranasal midazolam atomizer spray for procedural sedation in paediatric patients

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    Vijaykumara

    2016-09-01

    Conclusions: We can thereby say that administration of preservative free intranasal midazolam atomizer spray in dose of 0.2mg/kg as premedication in paediatric patients produces satisfactory level of sedation and anxiolysis with minimal adverse effects. [Int J Res Med Sci 2016; 4(9.000: 3850-3854

  20. Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam : a report on three cases

    NARCIS (Netherlands)

    ter Horst, HJ; Brouwer, OF; Bos, AF

    2004-01-01

    Continuous amplitude-integrated electroencephalogram (aEEG) recording with a cerebral function monitor is a useful tool to evaluate prognoses following perinatal asphyxia in term infants. Drugs may change the pattern of the conventional EEG. This report presents three infants treated with midazolam

  1. Simultaneous pharmacokinetics evaluation of human cytochrome P450 probes, caffeine, warfarin, omeprazole, metoprolol and midazolam, in common marmosets (Callithrix jacchus).

    Science.gov (United States)

    Uehara, Shotaro; Inoue, Takashi; Utoh, Masahiro; Toda, Akiko; Shimizu, Makiko; Uno, Yasuhiro; Sasaki, Erika; Yamazaki, Hiroshi

    2016-01-01

    1. Pharmacokinetics of human cytochrome P450 probes (caffeine, racemic warfarin, omeprazole, metoprolol and midazolam) composite, after single intravenous and oral administrations at doses of 0.20 and 1.0 mg kg(-1), respectively, to four male common marmosets were investigated. 2. The plasma concentrations of caffeine and warfarin decreased slowly in a monophasic manner but those of omeprazole, metoprolol and midazolam decreased extensively after intravenous and oral administrations, in a manner that approximated those as reported for pharmacokinetics in humans. 3. Bioavailabilities were ∼100% for caffeine and warfarin, but midazolam was 4% in marmosets, presumably because of contribution of marmoset P450 3A4 expressed in small intestine and liver, with a high catalytic efficiency for midazolam 1'-hydroxylation as evident in the recombinant system. 4. These results suggest that common marmosets, despite their rapid clearance of some human P450 probe substrates, could be an experimental model for humans and that marmoset P450s have functional characteristics that differ from those of human and/or cynomolgus monkey P450s in some aspects, indicating their importance in modeling in P450-dependent drug metabolism studies in marmosets and of further studies.

  2. The positive effects of Midazolam on functional activity of white rat brain cells in conditions of halothane anesthesia.

    Science.gov (United States)

    Vadachkoria, Z; Dzidziguri, L; Bakuradze, E; Dzidziguri, D

    2009-05-01

    For the elimination of postoperative complications, which are evident in infants with congenital palatine and upper lip cleft after halothane anesthesia during standard premedication (Atropine, Dimedrol) the usage of agents of benzodiazepine group with anti-hypoxic effects is advised. The latter may modulate the blocked ion channels by neuromediators, which are activated by GABA and GABA receptor function. The neuro-protective ability of halothane is demonstrated. To reveal the mechanisms of positive effects using benzodiazepine group for premedication we have investigated the effects of midazolam of brain cell functional activity of experimental animals (white rats) in conditions of halothane anesthesia. For the estimation of white rat brain cells functional activity the nuclear transcriptional activity was studied (based on the intensity of [14C]-UTF inclusion), also the glutamic acid decarboxilaze activity (GAD65/67) using immunohistochemistry. It is estimated that halothane inhibits the transcription in rat brain cells. During midazolam premedication the halothane inhibitory effect on RNA synthesis is not revealed. After an hour of pseudo-operation halothane also induces proved decrease of quantity of GAD65/67 positive cells in CA3 hippocampal field. At the same time the quantity of similar cells are increased in CA1 field. The increase of GAD65/67 positive cells in CA1 is more evident during midazolam premedication. Based on the data received we can conclude that the positive effect of midazolam results in increase of GAD65/67 positive cells in CA1 hippocampal field.

  3. The role of codeine phosphate premedication in fibre-optic bronchoscopy under insufficient local anaesthesia and midazolam sedation.

    Science.gov (United States)

    Tsunezuka, Y; Sato, H; Tsukioka, T; Nakamura, Y; Watanabe, Y

    1999-06-01

    Midazolam is widely used as a sedative agent to produce amnesia in patients undergoing fibre-optic bronchoscopy. However, if a patient does not receive sufficient local anaesthesia, continuous severe cough and physical movement may interrupt the procedure and reduce its safety. We therefore examined whether codeine phosphate is a useful premedication for bronchoscopy. The study design was a randomized comparison between codeine phosphate and a placebo in patients undergoing light local anaesthesia and midazolam sedation. We used low dose local anaesthesia (5 ml of nebulized 2% xylocaine) on the assumption of insufficient local anaesthesia. Patients were allocated to receive codeine phosphate 0.4 mg kg-1 or a saline placebo 60 min before they were sedated with i.v. midazolam. If the patients exhibited severe cough during bronchoscopy, intrabronchial supplemental local anaesthesia (2% xylocaine solution in 1 ml increments) was instilled via a bronchoscope to the trachea and segmental bronchi to suppress the cough. The dose of supplemental xylocaine was assessed and the requirements were significantly lower in the codeine group compared to the placebo group: 36.4 +/- 10.2 mg vs. 95.1 +/- 24.6 mg, respectively. After bronchoscopy, patients were interviewed by a doctor to assess their willingness to undergo a repeat procedure if one was clinically indicated, but no significant difference was observed between the two groups. If local anaesthesia is insufficient, midazolam together with codeine phosphate premedication is useful for both the patient and the bronchoscopist.

  4. Differential effects of midazolam and zolpidem on sleep-wake states and epileptic activity in WAG/Rij rats

    NARCIS (Netherlands)

    Depoortere, H.; Francon, D.; Luijtelaar, E.L.J.M. van; Drinkenburg, W.H.I.M.; Coenen, A.M.L.

    1995-01-01

    Hypnotic drugs are known to possess antiepileptic activity. Therefore, the effects of the benzodiazepine hypnotic midazolam (10 mg/kg) and the novel imidazopyridine hypnotic zolpidem (10 mg/kg) on sleep-wake states and on the number of spike-wave discharges were evaluated in WAG/Rij rats. Rats of

  5. Comparison of the Effect of Thiopental Sodium with Midazolam-ketamine on Post-tonsillectomy Agitation in Children

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    Maryam Toliyat

    2015-10-01

    Full Text Available The aim of this study was to determine the effect of thiopental sodium with that of midazolam-ketamine on relieving agitation after tonsillectomy in children. In a clinical trial, 50 children aged 5-10 years, candidates for tonsillectomy, were randomly divided into two 25-member groups. In the first group, thiopental sodium 5mg/kg/IV, and in the second group combination of midazolam 0.01 mg/kg/IV and ketamine 1 mg/kg/IV were used to induce anesthesia. The level of sedation was assessed after surgery with the Ramsay scale. There were no significant differences between the two groups in terms of heart rate, arterial oxygen pressure (PO2, and duration of anesthesia. The Ramsay sedation score was significantly higher in the thiopental sodium group than in the midazolam-ketamine group (P=0.01. Thiopental sodium can be more effective than the combination of midazolam-ketamine for controlling agitation after tonsillectomy in children.

  6. Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam : a report on three cases

    NARCIS (Netherlands)

    ter Horst, HJ; Brouwer, OF; Bos, AF

    Continuous amplitude-integrated electroencephalogram (aEEG) recording with a cerebral function monitor is a useful tool to evaluate prognoses following perinatal asphyxia in term infants. Drugs may change the pattern of the conventional EEG. This report presents three infants treated with midazolam

  7. Comparison of the Effects of Fentanyl and Midazolam as a Premedication in Children Undergoing Inguinal Hernial Surgery

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    MH Abdollahi

    2011-04-01

    Full Text Available Introduction: Premedication with midazolam can occasionally result in increased pediatric anxiety. In this study, we compared the effects of intravenous midazolam and fentanyl as pediatric premedication in children posted for inguinal hernia surgery. Methods: In this double blind randomized clinical trial study, sixty pediatric patients were randomly allocated to two study groups. Anesthesia was similar in both groups. Sedation score by Richmond agitation sedation scale was repeatedly measured on arrival to the preoperative part of the operating room, during drug administration, separation of the child from parent for transfer to the operating room, induction of anesthesia, time of transfer to the recovery room and discharge from the recovery room. Post-operative nausea and vomiting was also recorded. The collected data was analyzed with SPSS 15 and P value<0.05 was considered meaningful. Results: Baseline characteristics of the two study groups were similar. Mean RASS at separation of patients from parents; the time between the study drug administrations till separation from parents, induction of anesthesia and end of operation and need for additional drug during separation was significantly lower in the midazolam group. Opioid need in the fentanyl group was higher. Other findings were similar in the two groups. Conclusion: Use of fentanyl instead of midazolam as a premedication is not a priority in children posted for surgery.

  8. Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety.

    Science.gov (United States)

    Bellante, Flavio; Legros, Benjamin; Depondt, Chantal; Créteur, Jacques; Taccone, Fabio Silvio; Gaspard, Nicolas

    2016-04-01

    Current management guidelines for refractory status epilepticus (RSE) recommend the use of intravenous continuous anesthetic therapy, but there is little evidence to guide the selection of the most efficacious and safest drug. We conducted a retrospective study to evaluate the efficacy and safety of midazolam versus thiopental for treatment of RSE. Retrospective case-control series of prospectively identified patients treated with midazolam or thiopental for RSE between January 2007 and December 2014. The primary outcome was control of RSE. Secondary outcomes included the rate of adverse events, intensive care unit (ICU) and hospital length of stay, hospital mortality and long-term neurological outcome, assessed with the extended Glasgow outcome scale (GOS-E) at discharge and at six 6 months. A total of 33 patients were included, 19 treated with midazolam and 14 with thiopental. Groups were similar for demographic data, clinical variables, comorbidity and the underlying cause of RSE. The rate of control of SE did not differ between groups (63 vs. 64 %). Adverse events including hypotension (mean arterial pressure RSE; however, midazolam was associated with a significantly lower number of adverse events. These findings should be confirmed in larger multicenter trials.

  9. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor

    Science.gov (United States)

    Gonzalez Castro, Luis N.; Mehta, Jaideep H.; Brayanov, Jordan B.; Mullen, Gary J.

    2017-01-01

    Background Pre-operative administration of benzodiazepines can cause hypoventilation—a decrease in minute ventilation (MV)—commonly referred to as “respiratory compromise or respiratory depression.” Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room. In the present study we examined and quantified the onset of respiratory depression following the administration of a single dose of midazolam in pre-operative patients, using a non-invasive respiratory volume monitor that reports MV, tidal volume (TV), and respiratory rate (RR). Methods Impedance-based Respiratory Volume Monitor (RVM) data were collected and analyzed from 30 patients prior to undergoing orthopedic or general surgical procedures. All patients received 2.0 mg of midazolam intravenously at least 20 minutes prior to the induction of anesthesia and the effects of midazolam on the patient's respiratory function were analyzed. Results Within 15 minutes of midazolam administration, we noted a significant decrease in both MV (average decrease of 14.3% ± 5.9%, pbenzodiazepines affect primarily TV rather than RR. Such respiratory monitoring data provide the opportunity for individualizing dosing and adjustment of clinical interventions, especially important in elderly patients. With additional respiratory data, clinicians may be able to better identify and quantify respiratory depression, reduce adverse effects, and improve overall patient safety. PMID:28235069

  10. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

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    Ayse Ozcan

    2014-12-01

    Full Text Available Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after

  11. Inhibitory effect of single and repeated doses of nilotinib on the pharmacokinetics of CYP3A substrate midazolam.

    Science.gov (United States)

    Zhang, Hefei; Sheng, Jennifer; Ko, Jin H; Zheng, Cheng; Zhou, Wei; Priess, Petra; Lin, Wen; Novick, Steven

    2015-04-01

    Effects of single and repeated doses of nilotinib on the pharmacokinetics of midazolam, a cytochrome P450 3A (CYP3A) substrate, were assessed in 2 separate studies. In the single-dose nilotinib study, 18 healthy subjects were randomized to 6 treatment sequences to receive single dose of nilotinib 600 mg, midazolam 4 mg, and coadministration of both in a crossover manner. In the repeated-dose nilotinib study, 19 chronic myeloid leukemia patients took a single dose of midazolam 2 mg on days 1 and 13, and nilotinib 400 mg twice daily from days 2-13. In the single-dose study, the geometric mean ratio of the area under the plasma concentration time curve extrapolated to infinity (AUC(inf)) of midazolam plus nilotinib vs. midazolam was 1.3 (90%CI, 1.2-1.5) and the maximum observed serum concentration (C(max)) was 1.2 (90%CI, 1.0-1.4). In the repeated-dose study, the values for AUC(inf) and C(max) were 2.6 (90%CI, 2.1-3.3) and 2.0 (90%CI, 1.7-2.4), respectively. These results indicate that single-dose and repeated-dose administration of nilotinib results in weak and moderate inhibition of CYP3A, respectively. Therefore, appropriate monitoring and dose adjustment may be needed for drugs that are mainly metabolized by CYP3A, and have narrow therapeutic index, when coadministered with nilotinib.

  12. Nasal midazolam as a novel anticonvulsive treatment against organophosphate-induced seizure activity in the guinea pig.

    Science.gov (United States)

    Gilat, E; Goldman, M; Lahat, E; Levy, A; Rabinovitz, I; Cohen, G; Brandeis, R; Amitai, G; Alkalai, D; Eshel, G

    2003-03-01

    Seizures and status epilepticus, which may contribute to brain injury, are common consequences of exposure to organophosphorus (OP) cholinesterase inhibitors. Effective management of these seizures is critical. To investigate the efficacy of nasal midazolam as an anticonvulsive treatment for OP exposure, as compared to intramuscular midazolam, guinea pigs were connected to a recording swivel for electrocorticograph (ECoG) monitoring and clinical observation. The experimental paradigm consisted of pyridostigmine pretreatment (0.1 mg/kg i.m.) 20 min prior to sarin exposure (1.2x LD(50,) 56 micro g/kg i.m.). One minute post-exposure, atropine (3 mg/kg i.m.) and TMB-4 (1 mg/kg im) were administered. Within 3-8 min after sarin exposure all animals developed electrographic seizure activity (EGSA), with convulsive behavior. Treatment with midazolam (1 mg/kg i.m.) 10 min after the onset of EGSA abolished EGSA within 389+/-181 s. The same dose was not effective, in most cases, when given 30 min after onset. However, a higher dose (2 mg/kg) was found efficacious after 30 min (949+/-466 s). In contrast, nasal application of midazolam (1 mg/kg) was found most effective, with significant advantages, in amelioration of EGSA and convulsive behavior, when given 10 min (216+/-185 s) or 30 min (308+/-122 s) following the onset of EGSA ( P<0.001). Thus, nasal midazolam could be used as a novel, rapid and convenient route of application against seizure activity induced by nerve agent poisoning.

  13. Respiratory Rates and Arterial Blood-Gas Tensions in Healthy Rabbits Given Buprenorphine, Butorphanol, Midazolam, or Their Combinations

    Science.gov (United States)

    Schroeder, Carrie A; Smith, Lesley J

    2011-01-01

    The objective of this study was to evaluate the respiratory effects of buprenorphine, butorphanol, midazolam, and their combinations in healthy conscious rabbits. Six adult female New Zealand white rabbits were anesthetized briefly with isoflurane by mask to allow placement of a catheter into the central ear artery. After a 60-min recovery period, a baseline arterial sample was obtained. Animals then were injected intramuscularly with either 0.9% NaCl (1 mL), buprenorphine (0.03 mg/kg), butorphanol (0.3 mg/kg), midazolam (2 mg/kg), buprenorphine + midazolam (0.03 mg/kg, 2 mg/kg), or butorphanol + midazolam (0.3 mg/kg, 2 mg/kg). Arterial blood gases were evaluated at 30, 60, 90, 120, 180, 240, and 360 min after drug administration. All drug treatments caused significant decreases in respiratory rate, compared with saline. Buprenorphine and the combinations of midazolam–butorphanol and midazolam–buprenorphine resulted in statistically significant decreases in pO2. No significant changes in pCO2 pressure were recorded for any treatment. Increases in blood pH were associated with administration of butorphanol, midazolam, and the combinations of midazolam–butorphanol and midazolam–buprenorphine. In light of these results, buprenorphine and the combinations of midazolam–buprenorphine and midazolam–butorphanol result in statistically significant hypoxemia in rabbits that breathe room air. The degree of hypoxemia is of questionable clinical importance in these healthy subjects. Hypoxemia resulting from these drug combinations may be amplified in rabbits with underlying pulmonary or systemic disease. PMID:21439214

  14. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: A prospective randomized double blind trial

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    Ayushi Gupta

    2017-01-01

    Conclusion: Intranasal dexmedetomidine results in more successful parental separation and yields a higher sedation level at the time of induction of anesthesia than intranasal midazolam as premedication, with negligible side effects. However, its onset of action is relatively prolonged.

  15. Effect of a combination of oral midazolam and low-dose ketamine on anxiety, pain, swelling, and comfort during and after surgical extractions of mandibular third molars

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    Rubina Gupta

    2012-01-01

    Conclusions: Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

  16. Midazolam regulated caspase pathway, endoplasmic reticulum stress, autophagy, and cell cycle to induce apoptosis in MA-10 mouse Leydig tumor cells

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    So EC

    2016-04-01

    Full Text Available Edmund Cheung So,1,2 Yung-Chia Chen,3 Shu-Chun Wang,4 Chia-Ching Wu,4 Man-Chi Huang,4 Meng-Shao Lai,4 Bo-Syong Pan,4,5 Fu-Chi Kang,6 Bu-Miin Huang4 1Department of Anesthesia, An Nan Hospital, China Medical University, Tainan, Taiwan, Republic of China; 2Department of Anesthesia, School of Medicine, China Medical University, Taichung, Taiwan; Republic of China; 3Department of Anatomy, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; 4Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; 5Department of Cancer Biology, Wake Forest University School of Medicine, Winston Salem, NC, USA; 6Department of Anesthesia, Chi Mei Medical Center, Chiali, Tainan, Taiwan, Republic of China Purpose: Midazolam is widely used as a sedative and anesthetic induction agent by modulating the different GABA receptors in the central nervous system. Studies have also shown that midazolam has an anticancer effect on various tumors. In a previous study, we found that midazolam could induce MA-10 mouse Leydig tumor cell apoptosis by activating caspase cascade. However, the detailed mechanism related to the upstream and downstream pathways of the caspase cascade, such as endoplasmic reticulum (ER stress, autophagy, and p53 pathways plus cell cycle regulation in MA-10 mouse Leydig tumor cells, remains elusive.Methods: Flow cytometry assay and Western blot analyses were exploited.Results: Midazolam significantly decreased cell viability but increased sub-G1 phase cell numbers in MA-10 cells (P<0.05. Annexin V/propidium iodide double staining further confirmed that midazolam induced apoptosis. In addition, expressions of Fas and Fas ligand could be detected in MA-10 cells with midazolam treatments, and Bax translocation and cytochrome c release were also involved in midazolam-induced MA-10 cell apoptosis. Moreover, the staining and expression of LC3-II proteins could

  17. EVALUATION OF EFFICACY OF INTRANASAL MIDAZOLAM SPRA Y FOR PREANAESTHETIC MEDICATION IN PAEDIATRIC PATIENTS

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    Sneha P.

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: Preoperative anxiety and long-term behavioural pro blems are inevitable consequences in absence of preoperative sedation in paediatric patients undergoing surgery. An ideal premedicant removes fear and anxi ety in tender minds of children and achieves a calm, sedated child for smooth induction of anaesth esia and rapid recovery in postoperative period. Midazolam is the most commonly used premedicant in children as it satisfies most of the criteria of ideal premedicant but its route of administration i s a debatable issue in anaesthesia practice. AIMS: This study evaluated the efficacy of atomized intra nasal midazolam spray as a painless, user- friendly, needleless system of drug administration for pre-anaesthetic medication in paediatric patients. SETTINGS AND DESIGN: Tertiary hospital, a prospective, randomized, cont rolled, clinical study. METHODS AND MATERIAL: 60 ASA physical status I children of 2-5 years age group, weighing 10-18 kg scheduled for routine surgeries p articipated in the study. Children were randomly assigned to Group M: Received intranasal m idazolam spray in doses of 0.2 mg/kg and Group N: Received normal saline drops (1-2 drops/no stril. Patients were observed in preoperative room for 20 min. Acceptance of drug, response to dr ug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug were noted. STATISTICAL ANALYSIS: Student ‘t’ test, standard error of difference bet ween two means and Chi-square test. p value0.05. 20 min after p remedication 76.66% in group M and 10.00% group N, children showed satisfactory sedation (p<0 .05. 73.33% in group M while 26.66% in group N, children showed acceptable parental separa tion and 86.66% in group M while 23.33% group N, children showed satisfactory acceptance to mask (p<0.05. Transient nasal irritation in the form of rubbing of nose, watering, sneezing and lac rimation was observed in 40% children of

  18. Comparative study of the sedative and antinociceptive effects of levomepromazine, azaperone and midazolam in laboratory animals Estudo comparativo dos efeitos sedativos e antinociceptivos de levomepromazina, azaperone e midazolam em animais de laboratório

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    M.I. Mataqueiro

    2004-06-01

    Full Text Available The sedative and antinociceptive effects of levomepromazine, azaperone and midazolam were studied in rats and mice using three behavior evaluation methods. Both exploratory behavior and spontaneous locomotor activity were significantly diminished in a spontaneous locomotor activity test in open field when using levomepromazine and azaperone. However, the azaperone effects were short lived in comparison to levomepromazine effects. Midazolam caused reduction in exploratory activity with no effect in spontaneous locomotion. When assessing the antinociceptive effect in the tail flick reflex latency test after infliction of a pain stimulus in rats, tested drugs did not show any antinociceptive effect. The drugs studied were able to abolish the writhing reflex in mice when compared to control. Levomepromazine, azaperone and midazolam, at the doses were able to inhibit the exploratory behavior in rats, proving their sedative effect. Regarding the antinociceptive effects for visceral pain, these drugs were able to block contortions in mice.Os efeitos sedativos e antinociceptivos da levomepromazina, azaperone e midazolam foram avaliados utilizando-se três testes de comportamento em ratos e camundongos. No teste da atividade locomotora espontânea em campo aberto observou-se que tanto o comportamento exploratório como a atividade locomotora espontânea foram significativamente diminuídos quando se utilizou levomepromazina e azaperone. O efeito causado pelo azaperone foi menos prolongado quando comparado ao da levomepromazina. O midazolam causou diminuição do comportamento exploratório sem alterar a atividade locomotora espontânea. Quando se avaliou o efeito antinociceptivo por meio da latência para o reflexo da retirada da cauda em ratos após estímulo doloroso, as drogas não apresentaram nenhum efeito antinociceptivo observável. No teste das contorções em camundongos, os fármacos foram capazes de abolir as contorções quando comparados ao

  19. Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; MA Chang-sheng; DONG Jian-zeng; ZHAO Wen-du; LIU Xing-peng; KANG Jun-ping; LONG De-yong; YU Rong-hui; HU Fu-li; LIU Xiao-hui

    2007-01-01

    @@ Catheter ablation of atrial fibrillation (AF) has been increased dramatically recently.1 However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy.2,3 Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure.4However, there is few published work on the sedation regimen for catheter ablation of AF.

  20. Disruption of brain MEK-ERK sequential phosphorylation and activation during midazolam-induced hypnosis in mice: Roles of GABAA receptor, MEK1 inactivation, and phosphatase MKP-3.

    Science.gov (United States)

    Álvaro-Bartolomé, María; Salort, Glòria; García-Sevilla, Jesús A

    2017-04-03

    Midazolam is a positive allosteric modulator at GABAA receptor that induces a short hypnosis and neuroplasticity, in which the sequential phosphorylation of MEK1/2 and ERK1/2 was shown to play a role. This study investigated the parallel activation of p-MEK and p-ERK and regulatory mechanisms induced by midazolam through the stimulation of GABAA receptors in the mouse brain. During the time course of midazolam (60mg/kg)-induced sleep in mice (lasting for about 2h) p-Ser217/221 MEK1/2 was increased (+146% to +258%) whereas, unexpectedly, p-Tyr204/Thr202 ERK1/2 was found decreased (-16% to -38%), revealing uncoupling of MEK to ERK signals in various brain regions. Midazolam-induced p-MEK1/2 upregulation was prevented by pretreatment (30min) with flumazenil (10mg/kg), indicating the involvement of GABAA receptors. Also unexpectedly, midazolam-induced p-ERK1/2 downregulation was not prevented by flumazenil (10 or 30mg/kg). Notably, during midazolam-induced sleep the content of inactivated p-Thr286 MEK1, which can dampen ERK1/2 activation, was increased (+33% to +149%) through a mechanism sensitive to flumazenil (10mg/kg). Midazolam also increased MKP-3 (+13% to +73%) content and this upregulation was prevented by flumazenil (10mg/kg); an effect suggesting ERK inactivation because MKP-3 is the phosphatase selective for ERK1/2 dephosphorylation. The results indicate that during midazolam-induced sleep in mice there is an uncoupling of p-MEK (increased) to p-ERK (decreased) signals. p-ERK1/2 downregulation (not involving GABAA receptors) is the result of increased inactivated MEK1 and phosphatase MKP-3 (both effects involving GABAA receptors). These findings are relevant for the neurobiology and clinical use of benzodiazepines. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Intensive Farmaco- Surveillance of Interferon Alpha 2b Recombinant in Multiple Sclerosis. Farmacovigilancia intensiva al interferón alfa 2b recombinante en la esclerosis múltiple.

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    Hailen Bobillo López

    recombinant was safe in the treatment of the multiple sclerosis in these patients.

     

    Fundamento: El interferón alfa 2b recombinante, de producción nacional, se utiliza en el tratamiento de diferentes enfermedades, entre ellas la esclerosis múltiple. Para su comercialización se necesita conocer su margen de seguridad. Objetivo: Evaluar las reacciones adversas del interferón alfa 2b recombinante en el tratamiento de la esclerosis múltiple. Método: Durante el período comprendido entre 1996 y 2006, se revisaron las 70 historias clínicas y cuadernos de recogida de datos de los pacientes incluidos en el ensayo clínico nacional, fase IV aleatorizado, a doble ciegas, desarrollado en la Clínica de Esclerosis Múltiple del Hospital ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos. Con respecto al total de reacciones adversas manifestadas, se analizó tipo, tiempo de duración, empleo de tratamiento o no para contrarrestarlas, grado de intensidad (leve, moderada, grave o mortal y de causalidad (definitiva, probable, posible, condicional o no relacionada. Resultados: Del total de pacientes, 53 presentaron 207 reacciones adversas al interferón. Las más frecuentes fueron: fiebre, cefalea, escalofríos, artralgia, astenia y mialgia, siendo la mayoría efectos colaterales moderados y de carácter definitivo. En 197 pacientes el desenlace fue favorable. Conclusiones: El uso del interferón alfa 2β recombinante fue seguro en el tratamiento de la esclerosis múltiple en estos pacientes.

  2. A Comparative Study on the Sedative Effect of Oral Midazolam and Oral Promethazine Medication in Lumbar Puncture

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    Hojjat DERAKHSHANFAR

    2013-06-01

    Full Text Available How to Cite This Article: Derakhshanfar H, Modanlookordi M, Amini A, Shahrami A. A Comparative Study of the Sedative Effect of Oral Midazolam and Oral Promethazine Medication in Lumbar Puncture. Iran J Child Neurol. 2013 Spring;7(2:11-16. ObjectiveLumbar puncture (LP essentially is a painful and stressful procedure that indicated for diagnosis and therapeutic purposes. One way to reduce the anxiety is to administer an oral premedication. The aim of this study is to compare clinical effects of oral midazolam and oral promethazine in LP.Materials & MethodsThis prospective randomized controlled clinical trial study wasperformed on 80 children aged 2-7 years that were candidate for LP. They were divided into two randomized equal groups. First group received oral midazolam syrup 0.5 mg/kg and the other group received oral promethazine syrup 1mg/kg. Level of sedation, hemodynamic changes and any other complications were monitored every 5 minutes from 30 minutes before the start of the procedure.ResultsMidazolam group and promethazine group were similar in age, gender and weight. Midazolam had significantly shorter onset of sedation and also shorter duration to maximal sedation. The two groups were similar with respect to sedative effect at all time. The only complication that was significantly more in midazolam group was nausea and vomiting.ConclusionMidazolam syrup and promethazine syrup have same sedative effect in children. Both of these medications are easy to use in preschool children and none of them appeared to be superior to another. References1. Ellenby MS, Tegtmeyer K, Lai S, Braner DA. Lumbar Puncture. N Engl J Med 2006;28;355(13:e12.2. Crock C, Olsson C, Phillips R, Chalkiadis G, Sawyer S, Ashley D, et al. General anesthesia or conscious sedation for painful procedures in childhood cancer: The family’s perspective. Arch Dis Child 2003;88(3:253−7.3. Holdsworth MT, Raisch DW, Winter SS, Frost JD, Moro MA, Doran NH, et al. Pain and

  3. Comparison of biochemical stress indicators in juvenile captive estuarine crocodiles (Crocodylus porosus) following physical restraint or chemical restraint by midazolam injection.

    Science.gov (United States)

    Olsson, Annabelle; Phalen, David

    2013-07-01

    Using a prospective, randomized study design we demonstrate that midazolam sedation minimizes acidosis compared with physical restraint in captive juvenile estuarine crocodiles during handling or noninvasive procedures at preferred body temperature. A dose of midazolam (5.0 mg/kg) was administered intramuscularly into the forelimb of 20 male estuarine crocodiles weighing 2-3.5 kg. Their heart and respiratory rate and degree of sedation were monitored until recovery and then daily for 7 subsequent days. Blood samples were taken at 30, 60, 90, 180, and 360 min. We recorded lactate, partial pressure of carbon dioxide (CO2), hematocrit, glucose, and blood pH. A second group (1.9-2.6 kg) was physically restrained for 5 min and the same parameters recorded. Physically restrained animals demonstrated elevated heart rate, respiratory rate, glucose, lactate, and anion gap compared with the midazolam-treated group. Physically restrained animals had lower pH, bicarbonate, and partial pressure of CO2 compared with the midazolam-treated group. Behavior in the physically restrained group in the days following the study was disrupted, with reluctance to feed and bask, compared with midazolam-treated animals whose behavior was normal. We conclude that midazolam administered in the forelimb of captive estuarine crocodiles of 2-3.5 kg provides predictable onset and duration of sedation enabling physical examination, sample collection, and translocation of the animals with minimal disturbance to lactate, pH, and CO2. Behavior following recovery appears normal.

  4. Midazolam inhibits the formation of amyloid fibrils and GM1 ganglioside-rich microdomains in presynaptic membranes through the gamma-aminobutyric acid A receptor.

    Science.gov (United States)

    Yamamoto, Naoki; Arima, Hajime; Sugiura, Takeshi; Hirate, Hiroyuki; Kusama, Nobuyoshi; Suzuki, Kenji; Sobue, Kazuya

    2015-02-20

    Recent studies have suggested that a positive correlation exists between surgical interventions performed under general anesthesia and the risk of developing Alzheimer's disease (AD) in the late postoperative period. It has been reported that amyloid β-protein (Αβ) fibrillogenesis, which is closely related to AD, is accelerated by exposure to anesthetics. However, the mechanisms underlying these effects remain uncertain. This study was designed to investigate whether the anesthetic midazolam affects Αβ fibrillogenesis, and if so, whether it acts through GM1 ganglioside (GM1) on the neuronal surface. Midazolam treatment decreased GM1 expression in the detergent-resistant membrane microdomains of neurons, and these effects were regulated by the gamma-aminobutyric acid-A receptor. Midazolam inhibited Αβ fibril formation from soluble Αβ on the neuronal surface. In addition, midazolam suppressed GM1-induced fibril formation in a cell-free system. Moreover, midazolam inhibited the formation of Αβ assemblies in synaptosomes isolated from aged mouse brains. These finding suggested that midazolam has direct and indirect inhibitory effects on Αβ fibrillogenesis.

  5. Experimental study of midazolam as probe on evaluating activity of inhibited hepatic CYP3A

    Institute of Scientific and Technical Information of China (English)

    Xue-huiZHU; Jian-jieJIAO; Jian-shiLOU

    2005-01-01

    AIM To study the effect of ketoconazole (KTZ), a selective inhibitor of CYP3A, on in vivo and in vitro metabolic activity of hepatic CYP3A in rat with midazolam (MDZ) as probe, which was assessed by pharmacokinetic parameters of MDZ., and to establish a suitable marker or indicator for estimating drugmetabolizing activity of hepatic CYP3A. METHODS 1. In vivo study: Several loading doses of KTZ prepared in a mixture of PEG400 and propylene glycol (9:1) were administrated through rat sublingual vein followed by constant infusion at different rates through tail vein with an attempt to achieve corresponding steady-state plasma concentrations in order to attain continuous inhibition on CYP3A.

  6. Estudo comparativo dos efeitos do alprazolam e midazolam no controle da ansiedade em implantodontia

    OpenAIRE

    Ana Paula Guerreiro Bentes

    2012-01-01

    A sedação mínima deve ser considerada como parte do protocolo farmacológico nas cirurgias implantodônticas, já que os pacientes podem apresentar um grau aumentado de ansiedade, interrompendo o curso da intervenção, entre outras possíveis intercorrências. O objetivo deste trabalho foi avaliar, de forma comparativa, os efeitos do alprazolam e midazolam no controle da ansiedade neste tipo de intervenção. Cinquenta voluntários, ASA I ou ASA II, com indicação para a colocação de implantes dentário...

  7. Hexamethonium and midazolam terminate dysrhythmias and hypertension caused by intracerebroventricular bupivacaine in rabbits.

    Science.gov (United States)

    Bernards, C M; Artu, A A

    1991-01-01

    Previous studies have demonstrated that bupivacaine administered directly into the central nervous system (CNS) is capable of producing signs of bupivacaine cardiovascular toxicity. To investigate the mechanisms by which bupivacaine may act within the CNS to produce cardiovascular toxicity, we studied four groups of halothane-anesthetized rabbits in which infusion of intracerebroventricular (icv) bupivacaine or intravenous (iv) phenylephrine resulted in dysrhythmias and hypertension. In group 1 (n = 5), icv bupivacaine (500 +/- 79 micrograms [mean +/- SEM]) produced dysrhythmias lasting 73 +/- 13 min, whereas icv saline caused no dysrhythmias or hypertension. In group 2 (n = 9), icv bupivacaine-induced hypertension and dysrhythmias were abolished by icv midazolam in 4.4 +/- 0.6 min, and when dysrhythmias and hypertension recurred (22 +/- 0.9 min), hexamethonium (10 mg/kg iv) promptly terminated dysrhythmias and hypertension (14 +/- 1 s). In group 3 (n = 10), icv bupivacaine-induced dysrhythmias and hypertension were not affected by increasing the inspired halothane concentration from 0.8 to 1.6%. In group 4 (n = 6), iv phenylephrine-induced dysrhythmias and hypertension were not affected by icv midazolam. These results suggest that icv bupivacaine produces dysrhythmias and hypertension by increasing autonomic nervous system (ANS) outflow from the brain stem. The finding that peripheral autonomic blockade by hexamethonium rapidly terminated dysrhythmias and hypertension supports this mechanism. We speculate that icv bupivacaine produces an increase in autonomic outflow by blockade of the inhibitory gamma-aminobutyric acid (GABA) neurons that are known to be the principal tonic inhibitors of the ANS.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Comparison of sevoflurane with isoflurane for rapid mask induction in midazolam and butorphanol-sedated dogs.

    Science.gov (United States)

    Mutoh, T; Kojima, K; Takao, K; Nishimura, R; Sasaki, N

    2001-05-01

    Rapid mask induction can be a useful induction technique for veterinary patients, although it is often accompanied by exaggerated excitement responses in unpremedicated animals (Mutoh et al.: Jpn. J. Vet. Anesth. Surg. 26, 109-116; J. Vet. Med. Sci. 57, 1007-1013; J. Vet. Med. Sci. 57, 1121-1124; 1995). The aim of this study was to compare sevoflurane with isoflurane for rapid mask induction in six dogs sedated by a combination of midazolam (0.1 mg/kg) and butorphanol (0.2 mg/kg). Induction with sevoflurane (5%, 2.4 minimum alveolar concentration [MAC]) in O2 resulted in shorter time to loss of the palpebral reflex, negative tail clamp response, and successful intubation than with isoflurane (3%, 2.4 MAC) in O2. There were no changes in heart rate or mean arterial blood pressure during induction with sevoflurane, whereas an increase in heart rate was observed in dogs induced with isoflurane. A decrease in respiratory rate compared with the pre-induction rate was observed during induction, and associated mild respiratory acidosis, characterized by an increase in arterial PCO2, was measured at the end of the induction period in both induction groups. None of the animals had episodes of induction-related complications. These results suggest that both sevoflurane and isoflurane produce a smooth onset of induction in midazolam and butorphanol-sedated dogs. Sevoflurane is a more suitable for rapid mask induction than isoflurane since it provides faster induction associated with a lower blood/gas partition coefficient.

  9. Comparison of the Effects of Ketamine, Ketamine–Medetomidine, and Ketamine–Midazolam on Physiologic Parameters and Anesthesia-Induced Stress in Rhesus (Macaca mulatta) and Cynomolgus (Macaca fascicularis) Macaques

    OpenAIRE

    Lee, Vanessa K; Flynt, Kendall S; Haag, Lauren M; Taylor, Douglas K.

    2010-01-01

    This study compared the cardiovascular, respiratory, anesthetic, and glucocorticoid effects of ketamine alone with ketamine–medetomidine and ketamine–midazolam in rhesus and cynomolgus macaques. Macaques were given either intramuscular ketamine (10 mg/kg), intramuscular ketamine–medetomidine (3 mg/kg; 0.15 mg/kg), or oral midazolam (1 mg/kg) followed by intramuscular ketamine (8 mg/kg). The addition of medetomidine, but not midazolam, provided muscle relaxation and abolishment of reflexes tha...

  10. Propofol for Anesthesia and Postoperative Sedation Resulted in Fewer Inflammatory Responses than Sevoflurane Anesthesia and Midazolam Sedation after Thoracoabdominal Esophagectomy.

    Science.gov (United States)

    Nakanuno, Ryuichi; Yasuda, Toshimichi; Hamada, Hiroshi; Yoshikawa, Hiroshi; Nakamura, Ryuji; Saeki, Noboru; Kawamoto, Masashi

    2015-09-01

    Responses to surgical stress can be modulated by anesthetics. We prospectively compared the effects of two different anesthetic/sedative techniques on the peak postoperative bladder temperature (BT) and the postoperative C-reactive protein (CRP) level. Twenty patients who were scheduled to undergo elective thoracoabdominal esophagectomy were allocated to receive either propofol anesthesia followed by propofol sedation (PP group, n = 10) or sevoflurane anesthesia followed by midazolam sedation (SM group, n = 10). In each case, the patient's peak bladder temperature was measured on the morning after surgery, and their serum CRP levels were assessed on postoperative days (POD) 1, 2, and 3. The patients' postoperative clinical courses were also evaluated. The peak postoperative BT (degrees C) (37.6 ± 0.4 vs. 38.2 ± 0.6, respectively; p midazolam sedation.

  11. Stability of Fentanyl Citrate, Hydromorphone Hydrochloride, Ketamine Hydrochloride, Midazolam, Morphine Sulfate, and Pentobarbital Sodium in Polypropylene Syringes

    OpenAIRE

    Collin Anderson; Mark MacKay

    2015-01-01

    Purpose: Determine the stability of fentanyl 10 mcg/mL in 0.9% sodium chloride, fentanyl 10 mcg/mL in 5% dextrose, fentanyl 50 mcg/mL, hydromorphone 100 mcg/mL in 0.9% sodium chloride, ketamine 10 mg/mL, midazolam 0.4 mg/mL in 5% dextrose, midazolam 5 mg/mL, morphine 1 mg/mL in 0.9% sodium chloride, morphine 1 mg/mL in 5% dextrose, and pentobarbital 50 mg/mL when stored as single drug entities at room temperature in polypropylene syringes. Methods: Four 5 mL samples of each drug and concentra...

  12. Prosudba učinka midazolam-ketamina s deksmedetomidinom i fentanilom za injekcijsku anesteziju u pasa.

    OpenAIRE

    Santosh, Kambale M.; Ahmad, Raja A.; Kinjavdekar, Prakash; Aithal, Hari P.; Pawde, Abhijit M.; Kumar, Dinesh; Amarpal, Dr.

    2013-01-01

    Poduzeto je prospektivno istraživanje na 12 slučajno odabranih klinički zdravih pasa i kuja (prosječne tjelesne mase 18,34 ± 0,78 kg) podijeljenih u tri skupine (n = 4). Životinjama skupine A bio je intramuskularno primijenjen midazolam u dozi od 0,4 mg/kg i deksmedetomidin u dozi od 10 μg/kg. Životinjama skupine B bio je i/m primijenjen midazolam u dozi od 0,4 mg/kg i deksmedetomidin 20 μg/kg, a životinje skupine C primile su i/m 0,4 mg/kg midazolama, 20 μg/kg deksmedetomidina i 4 μg/kg fent...

  13. Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3‒6-year-old Uncooperative Dental Patients

    Directory of Open Access Journals (Sweden)

    Masoud Fallahinejad Ghajari

    2015-07-01

    Full Text Available Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety. Materials and methods. A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3‒6 (negative or definitely negative by Frankel scale, who required at least two similar dental treatment visits. Cases were ran-domly given ketamine (10 mg/kg and midazolam (0.5 mg/kg through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt’s scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test. Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures com-pared to oral sedation (P<0.05. Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05. The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physio-logical limits. Recovery time was longer in the intranasal group (P<0.001 with a more sleepy face (P=0.004. Conclusion. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children.

  14. Effects of ketamine and midazolam on morphology of dendritic spines in hippocampal CA1 region of neonatal mice

    Institute of Scientific and Technical Information of China (English)

    TAN Hong; REN Rong-rong; XIONG Zhi-qi; WANG Ying-wei

    2009-01-01

    Background It is a common phenomenon that children experience multiple general anesthesias in clinical practice, which raises the question whether repeated exposure to general anesthetics would interfere with the development of the central nervous system of children. The present study was designed to evaluate the effects of repeated treatment with ketamine or midazolam on postnatal dendrite development by examining the morphology of the dendritic spines of the pyramidal neurons in the hippocampal CA1 region in mice.Methods The transgenic green fluorescent protein-M line (GFP-M) mice were used in this study. Ketamine (100 mg/kg), midazolam (50 mg/kg) or saline (10 ml/kg) was administered intraperitoneally once a day on consecutive days from postnatal day 8 (P8) to postnatal day 12 (P12). At postnatal day 13 (P13) and postnatal day 30 (P30), the density and length of the apical dendritic spines of the pyramidal neurons in the hippocampal CA1 region were examined under a confocal microscope.Results At P13, for both the ketamine group and the midazolam group, the dendritic spines were found with a comparatively lower density and longer average length than in the control group. At P30, no significant difference in the density or average length of dendritic spines was found between the anesthetic group and control group.Conclusions This study indicated that repeated exposure to ketamine or midazolam in neonatal mice impaired dendritic spine maturation immediately afterwards, but this influence seemed to disappear during further postnatal development.

  15. Effectiveness of thiopentone, propofol and midazolam as an ideal intravenous anaesthetic agent for modified electroconvulsive therapy: A comparative study

    Directory of Open Access Journals (Sweden)

    Pratibha Jain Shah

    2010-01-01

    Full Text Available Modified electroconvulsive therapy (ECT is a safe and most effective treatment modality for major depressive disorders with suicidal tendencies. For this, one must have an ideal intravenous anaesthetic agent for induction which provides rapid onset, short duration of action, attenuates adverse physiological effect of ECT, rapid recovery without adverse shortening of seizure duration and minimum rise in serum potassium. The studies in search of an ideal intravenous anaesthetic agent are limited. Aim is to compare the effect of iv thiopentone, propofol and midazolam on induction time and quality, haemodynamics, Seizure duration, recovery time and changes in serum potassium level. 90 patients of ASA I and II of either sex having major depressive illness were randomly allocated into three groups (n = 30 based on iv induction agent used. Group I, Group II and Group III patients were induced with iv thiopentone 5 mg/kg, propofol 2 mg/kg and midazolam 0.2 mg/kg, respectively. The induction time, quality of induction, haemodynamic changes, seizure duration, recovery time and change in serum potassium level were measured and analyzed by Z test. Induction was quicker in propofol group i.e., 41.03 ± 6.11 sec than in thiopentone (50.6 ± 6.32 sec and midazolam group (77.30 ± 6.67 sec. Seizure duration was significantly shorter in midazolam group compared to propofol and thiopentone groups. Though significant rise in HR, SBP DBP was observed in all the three groups following ECT, but rise was significantly higher in thiopentone group compared to other two groups. Significantly, faster recovery was observed with propofol. Rise in serum potassium after ECT was not significant in any of the groups. Propofol is a safe and suitable intravenous anaesthetic agent for induction of anaesthesia for modified ECT.

  16. A comparative study of dexmedetomidine vs midazolam for sedation and hemodynamic changes during tympanoplasty and modified radical mastoidectomy

    Directory of Open Access Journals (Sweden)

    Dhara A. Vyas

    2013-10-01

    Full Text Available Background: The benzodiazepine, Midazolam, has been used medication given for sedation in tympanoplasty and mastoidectomy because of a number of beneficial effects. However, Dexmedetomidine is a highly selective α2-adrenoceptor agonist is emerging as preferred choice now a day. The aim of the study is to compare hemodynamic stability and sedation under Dexmedetomidine vs Midazolam during tympanoplasty and modified radical mastoidectomy done under local anaesthesia. Methods: After obtaining ethics clearance from institution and written informed consent from patients, 50 patients of age group 15 to 50 years of ASA grade i & ii were selected and divided in to two groups: Group D: Inj. Dexmedetomidine 1µg/kg over 15min, followed by 0.5µg/kg/hr (n= 25. Group M: Inj. Midazolam 0.05 mg/kg i.v. slowly, followed by 0.01mg/kg/hr (n= 25. Arterial blood pressure, heart rate and sedation level were monitored. The surgeons and patients were asked to rate their satisfaction, using the Likert scale. Results: Sedation score difference between group Dand group M was not statistically significant. There was no statistically significant difference found in diastolic blood pressure of both the groups. There was a significant reduction in heart rate in group D as compared to group M. Surgeon’s satisfaction score and patient’s satisfaction score both were high in group D compare to group M. Conclusions: For monitored anaesthesia care in ENT surgeries performed under local anaesthesia, inj. Dexmedetomidine could be a better alternative over inj. Midazolam. [Int J Basic Clin Pharmacol 2013; 2(5.000: 562-566

  17. Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial.

    Science.gov (United States)

    Canbay, Ozgur; Altiparmak, Basak; Celebi, Nalan; Karagoz, Heves; Saricaoglu, Fatma

    2015-01-01

    Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg(-1) for group P or midazolam 0.5 mg kg(-1) for group M with remifentanil 0.5 μg kg(-1) and cisatracurium 0.15 mg kg(-1) for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg(-1)h(-1) and in group M, midazolam 0.5 mg mg kg(-1) were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. Effect of a herbal extract containing curcumin and piperine on midazolam, flurbiprofen and paracetamol (acetaminophen) pharmacokinetics in healthy volunteers

    Science.gov (United States)

    Volak, Laurie P; Hanley, Michael J; Masse, Gina; Hazarika, Suwagmani; Harmatz, Jerold S; Badmaev, Vladimir; Majeed, Muhammed; Greenblatt, David J; Court, Michael H

    2013-01-01

    Aims Turmeric extract derived curcuminoids (curcumin, demethoxycurcumin and bisdemethoxycurcumin) are currently being evaluated for the treatment of cancer and Alzheimer's dementia. Previous in vitro studies indicate that curcuminoids and piperine (a black pepper derivative that enhances curcuminoid bioavailability) could inhibit human CYP3A, CYP2C9, UGT and SULT dependent drug metabolism. The aim of this study was to determine whether a commercially available curcuminoid/piperine extract alters the pharmacokinetic disposition of probe drugs for these enzymes in human volunteers. Methods A randomized placebo-controlled six way crossover study was conducted in eight healthy volunteers. A standardized curcuminoid/piperine preparation (4 g curcuminoids plus 24 mg piperine) or matched placebo was given orally four times over 2 days before oral administration of midazolam (CYP3A probe), flurbiprofen (CYP2C9 probe) or paracetamol (acetaminophen) (dual UGT and SULT probe). Plasma and urine concentrations of drugs, metabolites and herbals were measured by HPLC. Subject sedation and electroencephalograph effects were also measured following midazolam dosing. Results Compared with placebo, the curcuminoid/piperine treatment produced no meaningful changes in plasma Cmax, AUC, clearance, elimination half-life or metabolite levels of midazolam, flurbiprofen or paracetamol (α = 0.05, paired t-tests). There was also no effect of curcuminoid/piperine treatment on the pharmacodynamics of midazolam. Although curcuminoid and piperine concentrations were readily measured in plasma following glucuronidase/sulfatase treatment, unconjugated concentrations were consistently below the assay thresholds (0.05–0.08 μm and 0.6 μm, respectively). Conclusion The results indicate that short term use of this piperine-enhanced curcuminoid preparation is unlikely to result in a clinically significant interaction involving CYP3A, CYP2C9 or the paracetamol conjugation enzymes. PMID:22725836

  19. Mild Hypothermia Decreases Fentanyl and Midazolam Steady-State clearance in a Rat Model of Cardiac Arrest

    Science.gov (United States)

    Empey, Philip E.; Miller, Tricia M.; Philbrick, Ashley H.; Melick, John; Kochanek, Patrick M.; Poloyac, Samuel M.

    2011-01-01

    Objectives Therapeutic hypothermia is widely-employed for neuroprotection after cardiac arrest(CA). However, concern regarding elevated drug concentrations during hypothermia and increased adverse drug reaction risk complicates concurrent pharmacotherapy. Many commonly used medications in critically ill patients rely on the cytochrome P450(CYP) 3A isoform for their elimination. Therefore, our study objectives were to determine the effect of mild hypothermia on the in vivo pharmacokinetics of fentanyl and midazolam, two clinically-relevant CYP3A substrates, after CA and to investigate the mechanisms of these alterations. Design Prospective, randomized, controlled study Setting University research laboratory Subjects Thirty two adult male Sprague-Dawley rats Interventions An asphyxial CA rat model was used and mild hypothermia(33 °C) was induced 1h post injury by surface cooling and continued for 10 hours to mimic the prolonged clinical application of hypothermia accompanied by intensive care interventions. Fentanyl and midazolam were independently administered by intravenous infusion and plasma and brain concentrations were analyzed using ultra-performance liquid chromatography tandem mass spectrometry. Cyp3a2 protein expression was measured and a Michaelis-Menten enzyme kinetic analysis was performed at 37°C and 33°C using control rat microsomes. Measurements and Main Results Mild hypothermia decreased the systemic clearance of both fentanyl (61.5±11.5 to 48.9±8.95 mL/min/kg;p midazolam (89.2±12.5 to 73.6±12.1 mL/min/kg;p midazolam in rats after CA through alterations in Cyp3a metabolic capacity rather than enzyme affinity as observed with other CYPs. Contrasting effects on blood and brain levels further complicates drug dosing. Consideration of the impact of hypothermia on medications whose clearance is dependent on CYP3A metabolism is warranted. PMID:22067624

  20. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor.

    Science.gov (United States)

    Gonzalez Castro, Luis N; Mehta, Jaideep H; Brayanov, Jordan B; Mullen, Gary J

    2017-01-01

    Pre-operative administration of benzodiazepines can cause hypoventilation-a decrease in minute ventilation (MV)-commonly referred to as "respiratory compromise or respiratory depression." Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room. In the present study we examined and quantified the onset of respiratory depression following the administration of a single dose of midazolam in pre-operative patients, using a non-invasive respiratory volume monitor that reports MV, tidal volume (TV), and respiratory rate (RR). Impedance-based Respiratory Volume Monitor (RVM) data were collected and analyzed from 30 patients prior to undergoing orthopedic or general surgical procedures. All patients received 2.0 mg of midazolam intravenously at least 20 minutes prior to the induction of anesthesia and the effects of midazolam on the patient's respiratory function were analyzed. Within 15 minutes of midazolam administration, we noted a significant decrease in both MV (average decrease of 14.3% ± 5.9%, pmidazolam administration on clinically significant respiratory parameters (MV, TV and RR) using a non-invasive RVM, uncovering that the respiratory depressive effect of benzodiazepines affect primarily TV rather than RR. Such respiratory monitoring data provide the opportunity for individualizing dosing and adjustment of clinical interventions, especially important in elderly patients. With additional respiratory data, clinicians may be able to better identify and quantify respiratory depression, reduce adverse effects, and improve overall patient safety.

  1. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction.

    Science.gov (United States)

    Yu, C; Li, S; Deng, F; Yao, Y; Qian, L

    2014-09-01

    Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). Recorded variables were patient preoperative anxiety scores, vital signs, visual analogue scale (VAS) pain scores, Observer's Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, surgeon and patient degree of satisfaction, and the duration of analgesia after surgery. The OAAS scores were significantly lower for patients administered D/F compared to those who received M/F. The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3 h) than in those who received M/F (4.1 h; P=0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P=0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.

  2. COMPARISON BETWEEN DEXMEDETOMIDINE-S-KETAMINE AND MIDAZOLAM-S-KETAMINE IN IMMOBILIZATION OF ONCILLA (LEOPARDUS TIGRINUS).

    Science.gov (United States)

    Lima, Caio Filipe da Motta; Cortopassi, Silvia Renata Gaido; de Moura, Claudio Alves; de Mattos, Ewaldo; das Candeias, Isis Zanini; Pedron, Bruno Gregnanin; Teixeira, Rodrigo Hidalgo Friciello; Dias Neto, Ramiro das Neves

    2016-03-01

    Established immobilization protocols are required for safe procedures on wildlife and zoo animals. This study evaluated the cardiovascular, respiratory, and anesthetic effects of dexmedetomidine (40 μg/kg) with S-ketamine (5 mg/kg) and midazolam (0.5 mg/kg) with S-ketamine (5 mg/kg) in 12 specimens of oncilla (Leopardus tigrinus) at Quinzinho de Barros Municipal Zoo Park in Sorocaba, São Paulo, Brazil, between January and March 2010. Each animal underwent both protocols, totaling 24 anesthetic procedures. The dexmedetomidine-S-ketamine group (DK) showed a decrease in heart rate compared to initial values and significantly lower heart rate and oxyhemoglobin saturation values compared to Midazolam-S-Ketamine Group (MK). Four animals in DK had episodes of sinus pauses. Systemic blood pressure, respiratory frequency, and rectal temperature showed no significant differences between groups. The dexmedetomidine-S-ketamine group showed a greater degree of muscle relaxation and allowed for more thorough and longer oral evaluations. The dexmedetomidine-S-ketamine group had a shorter period of recumbency, longer period to return of muscle tone, and shorter recovery time. Two animals in MK did not reach recumbency. The dexmedetomidine-S-ketamine group had better qualities of induction and recovery. It may be concluded that both protocols can be safely used in oncillas. Midazolam-S-ketamine promotes effective chemical restraint for quick and minimally invasive procedures and dexmedetomidine-S-ketamine promotes effective chemical restraint for prolonged and more invasive procedures.

  3. 咪唑安定临床应用进展%Advances in the clinical use of midazolam

    Institute of Scientific and Technical Information of China (English)

    刘红菊; 黄宇光

    2009-01-01

    Midazolam,a benzodiazepine with short half-life,perfect potency,and slight influence on hemodynamics,has a pharmacologic profile including sedation,anticonvulsant and anterograde amnesia.Lots of attention was paid to the use of midazolam in premedication of general anesthesia,conscious sedation for outpatients in short procedures or examinations,sedation in intensive care units(ICU),treatment of childhood status epilepticus,and intrathecal analgesia.This review focuses on the advance in clinical use of midazolam.%咪唑安定具有镇静、抗惊厥和顺行性遗忘等作用,其半衰期短,效能强,对血流动力学影响轻微.咪唑安定在麻醉术前用药、门诊短小手术或检查操作、ICU镇静、小儿癫痫持续状态的控制及椎管内辅助镇痛等领域的应用,都受到了较多关注.现就咪唑安定在以上领域的研究进展作一综述.

  4. Comparison between intranasal and intravenous midazolam sedation (with or without patient control) in a dental phobia clinic.

    Science.gov (United States)

    Kaufman, E; Davidson, E; Sheinkman, Z; Magora, F

    1994-08-01

    Two new modes of sedation; patient-controlled sedation (PCS) and intranasal sedation (INS) were compared with the traditional bolus intravenous sedation (BIVS) while delivering dental care to apprehensive patients in a specialized dental fear clinic. Effective sedation was evaluated in a randomized, prospective study in 42 ASA 1 and 2 patients, in a factorial design. Eighteen patients were sedated with .5% midazolam INS. Ten patients received intravenous PCS via a patient-controlled analgesia pump containing midazolam, and 14 patients received intermittent intravenous boluses of 1 mg midazolam given as needed (BIVS). Appropriate local anesthetic nerve blocks with 2% lidocaine with 1:100,000 epinephrine, and supplementary inhalation of nitrous oxide and oxygen via a nasal mask, were also given to all patients in the study. The dosage requirement with PCS was higher than that found with INS or BIVS. However, PCS produced some anxiety reduction when compared with INS and BIVS. It also reduced interfering movements during treatment more effectively than the other sedation modes. No complications were detected in any of the patients and they were able to leave the clinic within 1 hour after completion of treatment.

  5. A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil.

    Science.gov (United States)

    Girdler, N M; Lyne, J P; Wallace, R; Neave, N; Scholey, A; Wesnes, K A; Herman, C

    2002-09-01

    Flumazenil is traditionally administered intravenously to reverse the adverse effects of over sedation with benzodiazepines. The aim of this study was to test postoperative cognitive and psychomotor recovery from midazolam conscious sedation, following reversal with orally administered flumazenil. It was hypothesised that when administered by the oral route, flumazenil may enhance recovery over a prolonged period, thus increasing safety. Eighteen patients requiring intravenous midazolam sedation for dental treatment completed a randomised, double-blind, crossover trial. Following treatment the patients' sedation was reversed using either flumazenil or saline (as placebo), administered orally, on alternate appointments. Assessment of mood and cognitive function were undertaken using ClinPhone.cdr(R), a highly sensitive and specific computerised battery of cognitive tests administered by telephone prior to sedation and every hour for seven hours post reversal. Results indicate that within 20 min of administration, oral flumazenil is capable of partially reversing some cognitive and psychomotor impairments but the attentional and stimulus discrimination effects of midazolam sedation still remain.

  6. Effect of Oral Midazolam Premedication on Children’s Co-operation Before General Anesthesia in Pediatric Dentistry

    Science.gov (United States)

    Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

    2014-01-01

    Statement of the Problem: Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. Purpose: This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. Materials and Method: In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Results: Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Conclusion: Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events. PMID:25191661

  7. BLOOD PRESSURE CHANGES OF ELDERLY HYPERTENSIVE PATIENTS DURING DENTAL EXTRACTION UNDER SEDATION WITH CONTINUOUS INTRAVENOUS INFUSION OF MIDAZOLAM

    Institute of Scientific and Technical Information of China (English)

    Ji-zhi Zhao; Kuo Wan; Quan Jing; Xi Chen

    2007-01-01

    Objective To evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam.Methods One hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind , randomized, controlled study. Patients in intervention group (n - 50) were given midazolam dissolved in glucose solution and patients in control group (n = 50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points.Results Under basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P< 0. 05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P< 0. 05), but coefficient of variation did show significant difference in both groups.Conclusion Continuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.

  8. Midazolam Versus Ketamine in the Management of Emergence Agitation in Children Undergoing Lower Abdominal and Limb Surgeries

    Directory of Open Access Journals (Sweden)

    Danesh H

    2012-02-01

    Full Text Available Background: Emergence agitation (EA is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years.Methods: In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam (28 or 0.5 mg/kg ketamine (29 by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation (agitation score, severity of pain (pain score, anesthesia, recovery and extubation durations were recorded postoperatively.Results: The prevalence of agitation in midazolam (21.4% was lower than ketamine group (34.5%; P0.05.Conclusion: The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children.

  9. Intestinal CYP3A4 and Midazolam Disposition in vivo Associate with VDR Polymorphisms and Show Seasonal Variation

    Science.gov (United States)

    Thirumaran, Ranjit K.; Lamba, Jatinder K.; Kim, Richard B.; Urquhart, Brad L.; Gregor, Jamie C.; Chande, Nilesh; Fan, Yiping; Qi, An; Cheng, Cheng; Thummel, Kenneth E.; Hall, Stephen D.

    2013-01-01

    Vitamin D, whose levels vary seasonally with sunlight, is activated to 1α,25-dihydroxyvitamin D3 that binds the vitamin D receptor (VDR) and transcriptionally regulates intestinal CYP3A4 expression. We genotyped VDR polymorphisms and determined their associations with intestinal CYP3A4 and with midazolam pharmacokinetics, and whether intestinal CYP3A4 levels/activity varied seasonally. The VDR BsmIG>A (rs1544410) polymorphism was significantly associated with CYP3A4 jejunal expression/activity, withCYP3A4 duodenal mRNA, and with midazolam area under the curve (AUC). Intestinal CYP3A4 expression/activity was significantly higher in biopsies with the VDR promoter polymorphisms Cdx2-3731G>A and GATA-1012A>G that increase VDR activation of target genes. Duodenal CYP3A4 mRNA was significantly higher between April and September than between October and March. Midazolam p.o. AUC and oral bioavailability trended higher October through March compared to April through September. These data suggest VDR polymorphisms are predictors of intestinal CYP3A4, and that CYP3A4 intestinal expression varies seasonally - likely related to annual changes in UV sunlight and vitamin D levels. PMID:22484315

  10. Comparison of short-term effects of midazolam and lorazepam in the intra-amygdala kainic acid model of status epilepticus in mice.

    Science.gov (United States)

    Diviney, Mairead; Reynolds, James P; Henshall, David C

    2015-10-01

    Benzodiazepines remain as the first-line treatment for status epilepticus (SE), but debate continues as to the choice and delivery route of pharmacotherapy. Lorazepam is currently the preferred anticonvulsant for clinical use, but midazolam has become a popular alternative, particularly as it can be given by nonintravenous routes. Anticonvulsants are also commonly used to terminate SE in animal models. Here, we aimed to compare the efficacy of midazolam with that of lorazepam in an experimental model of focal-onset SE. Status epilepticus was induced by intra-amygdala microinjection of kainic acid in 8week old C57Bl/6 mice. Forty minutes later, mice were treated with an intraperitoneal injection of either lorazepam or midazolam (8mg/kg). Electroencephalogram (EEG) activity, histology, and behavioral tests assessing recovery of function were evaluated and compared between groups. Intraperitoneal injection of either lorazepam or midazolam resulted in similar patterns of reduced EEG epileptiform activity during 1-hour recordings. Damage to the hippocampus and presentation of postinsult anxiety-related behavior did not significantly differ between treatment groups at 72h. However, return of normal behaviors such as grooming, levels of activity, and the evaluation of overall recovery of SE mice were all superior at 24h in animals given midazolam compared with lorazepam. Our results indicate that midazolam is as effective as lorazepam as an anticonvulsant in this model while also providing improved animal recovery after SE. These data suggest that midazolam might be considered by researchers as an anticonvulsant in animal models of SE, particularly as it appears to satisfy the requirements of refining procedures involving experimental animals at early time-points after SE.

  11. Síndrome de abstinência associada à interrupção da infusão de fentanil e midazolam em pediatria Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics

    Directory of Open Access Journals (Sweden)

    J.N. Bicudo

    1999-03-01

    Full Text Available OBJETIVO: Determinar a ocorrência de síndrome de abstinência em crianças internadas em UCI Pediátrica em uso de fentanil e midazolam. MÉTODOS: Avaliadas 36 crianças internadas na UCI Pediátrica do Hospital São Paulo - Universidade Federal de São Paulo, no período de março a setembro de 1997, com idade variando de 5 dias a 22 meses (22 masc : 14 fem que fizeram uso de fentanil e midazolam por mais de 24 horas. Utilizado o Escore Neonatal de Abstinência adaptado por Finnegan que determina a ocorrência de síndrome de abstinência em crianças menores de 2 anos. Escore maior ou igual a 8 é considerado como síndrome de abstinência. Correlacionados a síndrome de abstinência com a dose total acumulada, velocidade de infusão, dose diária e tempo de utilização do fentanil e do midazolam. RESULTADOS: Determinada síndrome de abstinência em 18 (50% das 36 crianças. Aplicado o teste estatístico de Mann Whitney para comparar os grupos com e sem síndrome de abstinência. Dose total acumulada de fentanil (5732.7 ± 5114.91 vs. 624.2 ± 591.2mcg, pPURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU in fentanyl use and midazolam METHODS: Evaluation of 36 children interned in PICU of the Hospital São Paulo - Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam. RESULTS: Certain abstinence syndrome in 18 (50% of the 36 children. Applied Mann Whitney's statistical

  12. Effects of propofol, midazolam and thiopental sodium on outcome and amino acids accumulation in focal cerebral ischemia-reperfusion in rats

    Institute of Scientific and Technical Information of China (English)

    陈莲华; 贡沁燕; 肖常思

    2003-01-01

    Objective To investigate the effects of propofol, midazolam and thiopental sodium on outco mes and amino acid accumulation in focal cerebral ischemia-reperfusion in rats .Methods Male Sprague Dawley (SD) rats were scheduled to undergo 3-hour middle cerebral artery occlusion by intraluminal suture and 24-hour reperfusion. Neurologic outcomes were scored on a 0-5 grading scale. Infarct volume was shown with triphenyltetrazolium c hloride staining and measured by an image analysis system. Concentrations of va rious amino acids (aspartate, glutamate, glycine, taurine, and gama-aminobutyri c acid) were measured after 3 hours of reperfusion using high performance liquid chromatography. Propofol, midazolam and thiopental sodium were given intraperi toneally at the beginning of reperfusion.Results Both propofol and midazolam attenuated neurological deficits and reduced infarct and edema volumes. Propofol showed better neurological protection than midazol am while thiopental sodium did not exhibit any protective effect. Both propofol and midazolam decreased excitatory amino acids accumulation, while propofol inc reased gama-aminobutyric acid accumulation in ischemic areas in reperfusion. Conclusion Propofol and midazolam, but not thiopental sodium, may provide protective effect s against reperfusion induced injury in rats subjected to focal cerebral ischemia. This neurological protection may be due to the acceleration of excitatory am ino acids elimination in reperfusion.

  13. Investigation of the pharmacokinetic interactions of deferasirox, a once-daily oral iron chelator, with midazolam, rifampin, and repaglinide in healthy volunteers.

    Science.gov (United States)

    Skerjanec, Andrej; Wang, Jixian; Maren, Kelly; Rojkjaer, Lisa

    2010-02-01

    Deferasirox, a newly developed iron chelator, was coadministered orally with either a known inducer of drug metabolism or with cosubstrates for cytochrome P450 (CYP) to characterize the potential for drug-drug interactions. In the induction assessment, single-dose deferasirox pharmacokinetics were obtained in the presence and absence of a repeated-dose regimen of rifampin. In the CYP3A interaction evaluation, midazolam and its active hydroxylated metabolite were assessed after single doses of midazolam in the presence and absence of steady-state concentrations of deferasirox. To test for interaction at the level of CPY2C8, single-dose repaglinide pharmacokinetics/pharmacodynamics were determined with and without repeated-dose administration of deferasirox. After rifampin, a significant reduction (44%) in plasma exposure (AUC) to deferasirox was observed. Upon coadministration of midazolam, there was a modest reduction of up to 22% in midazolam exposure (AUC, C(max)), suggesting a modest induction of CYP3A4/5 by deferasirox. Def erasirox caused increases in repaglinide plasma C(max) and AUC of 1.5-fold to over 2-fold, respectively, with little change in blood glucose measures. Specific patient prescribing recommendations were established when coadministering deferasirox with midazolam, repaglinide, and rifampin. These recommendations may also apply to other substrates of CYP3A4/5 and CYP2C8 or potent inducers of glucuronidation.

  14. Sedation of children for auditory brainstem response using ketamine-midazolam-atropine combination - a retrospective analysis.

    Science.gov (United States)

    Bocskai, Tímea; Németh, Adrienne; Bogár, Lajos; Pytel, József

    2013-12-01

    Authors investigated sedation quality in children for auditory brainstem response testing. Two-hundred and seventy-six sedation procedures were retrospectively analyzed using recorded data focusing on efficacy of sedation and complications. Intramuscular ketamine-midazolam-atropine combination was administered on sedation preceded by narcotic suppository as pre-medication. On using the combination vital parameters remained within normal range, the complication rate was minimal. Pulse rate, arterial blood pressure and pulse oxymetry readings were stable, hypoventilation developed in 4, apnoea in none of the cases, post-sedation agitation occurred in 3 and nausea and/or vomiting in 2 cases. Repeated administration of narcotic agent was necessary in a single case only. Our practice is suitable for the sedation assisting hearing examinations in children. It has no influence on the auditory brainstem testing, the conditions necessary for the test can be met entirely with minimal side-effects. Our practice provides a more lasting sedation time in children during the examination hence there is no need for the repetition of the narcotics.

  15. Midazolam sedation increases fluctuation and synchrony of the resting brain BOLD signal.

    Science.gov (United States)

    Kiviniemi, Vesa J; Haanpää, Hannu; Kantola, Juha-Heikki; Jauhiainen, Jukka; Vainionpää, Vilho; Alahuhta, Seppo; Tervonen, Osmo

    2005-05-01

    The blood oxygen level-dependent (BOLD) magnetic resonance signal of functional brain cortices is dominated by very low frequency (VLF) fluctuations in anesthetized child patients. The temporal synchrony of the BOLD signal is also higher in anesthetized children compared with awake adults. The origin of the synchronous fluctuations can be related to maturation, pathological status or the anesthesia used in the imaging. Two of the three confounding variables (maturation and pathology) were controlled in this study. The effect of midazolam (4+/-0.8 mg) sedation on the BOLD signal was assessed in 12 healthy adults (aged 24+/-1.5 years) at 1.5 T. The VLF fluctuation power and temporal synchrony of the BOLD signal increased significantly after the sedation in the auditory and visual cortices. The fast Fourier transformation power spectral baseline fit parameters of the BOLD signal were also found to change significantly after sedation. It is concluded that the VLF fluctuation and temporal synchrony of the BOLD signal become increased after sedation in functional brain regions.

  16. Preliminary investigation into the ventilatory effects of midazolam in isoflurane-anaesthetised goats

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    George F. Stegmann

    2012-04-01

    Full Text Available The ventilatory effects of intravenous midazolam (MDZ were evaluated in isoflurane- anaesthetised goats. Eight female goats aged 2–3 years were fasted from food and water for 12 h. Anaesthesia was then induced using a face mask with isoflurane in oxygen, whilst the trachea was intubated with a cuffed tracheal tube and anaesthesia maintained with isoflurane at 1.5% end-tidal concentration. Ventilation was spontaneous. The goats were treated with either a saline placebo (PLC or MDZ intravenously at 0.2 mg/kg. Analysis of variance for repeated measures was used for the analysis of data. Significance was taken at the 0.05 level. Differences between treatments were not statistically significant (p > 0.05 for tidal volume, ventilation rate, tidal volume/kg (VT/kg and end-tidal carbon dioxide partial pressure. Within treatments, VT and VT/kg differed 5 min after MDZ administration; this was statistically significant (p < 0.05. The occurrence of apnoea in the MDZ-treated goats was statistically significant (p = 0.04 compared with the PLC treated goats. Intravenous MDZ at 0.2 mg/kg administered to isoflurane-anaesthetised goats may result in transient apnoea and a mild decrease in VT and VT/kg.

  17. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in the Treatment of Refractory Serial Seizures in Children

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    Afshin FAYYAZI

    2012-09-01

    Full Text Available How to Cite this Article: Fayyazi A, Karimzadeh P, Torabian S, Damadi S, Khaje A. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in The Treatment of Refractory Serial Seizures in Children. Iran J Child Neurol 2012; 6(3: 15-19. ObjectiveSerial seizures occur commonly in inpatient epileptic children. This type ofseizure due to its characteristics has a significant impact on the patient’s health.Untreated serial seizures lead to status epilepticus; therefore, finding a moreeffective treatment for such patients is essential. This study was performed tocompare the outcome of intermittent intravenous diazepam in the pediatricneurology clinic and intravenous midazolam in the pediatric intensive care unit(PICU, in order to introduce an alternative treatment for serail seizures.Materials & MethodsIn this study, 38 inpatient children aged 6 mo-15 years with refractory serialseizures were treated by first line antiepileptic drugs and then randomlytreated with either intermittent intravenous diazepam in the neurology ward orintravenous midazolam in PICU.ResultsFourteen (70% diazepam group patients and 13 (72.2% midazolam grouppatients had good response to treatment, there was no significant differencebetween the two groups. Four midazolam group patients and two diazepamgroup patients needed mechanical ventilation and were intubated duringtreatment, with no significant difference between the two groups. Durationsof mechanical ventilation and PICU and hospital stay were not significantlydifferent between the two groups.ConclusionIntermittent intravenous diazepam is an effective alternative therapy formidazolam drip in the treatment of serial seizures due to similar therapeuticeffects and fewer side effects.ReferencesHaut SR. Seizure clustering. Epilepsy Behav 2006Feb;8(1:50-5.Caraballo RH, Cersosimo RO, Fejerman N. Benign focal seizures of adolescence: a prospective study. Epilepsia 2004 Dec;45(12:1600-3.Haut SR, Swick C

  18. Inhibition of neophobia-stimulated c-Fos expression in the dorsomedial part of the prefrontal cortex in rats pretreated with midazolam.

    Science.gov (United States)

    Wisłowska-Stanek, Aleksandra; Lehner, Małgorzata; Skórzewska, Anna; Bidziński, Andrzej; Turzyńska, Danuta; Sobolewska, Alicja; Maciejak, Piotr; Szyndler, Janusz; Płaźnik, Adam

    2008-01-01

    The effect of an anxiolytic drug, midazolam, on the expression of c-Fos protein (the product of the immediate early gene, c-fos) in the rat brain was studied in animals that were exposed to the stress of neophobia using the open field test. Midazolam (0.5 mg/kg, ip) selectively and significantly attenuated the neophobia-induced increase in the number of Fos-like immunoreactive neurons in the dorsomedial part of the prefrontal cortex, but not in the primary motor cortex, the piriform cortex or the amygdalar nuclei. Overall, the effects of midazolam indicate that the prefrontal cortex is a likely candidate region in which drugs exert their anxiolytic action, and that the dorsomedial part of the prefrontal cortex may participate in the formation and expression of acute innate fear responses.

  19. Ketamine and midazolam differently impact post-intubation hemodynamic profile when used as induction agents during emergency airway management in hemodynamically stable patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Zuin, Marco; Rigatelli, Gianluca; Dell'Avvocata, Fabio; Faggian, Giuseppe; Conte, Luca; Giatti, Sara; Michielan, Flavio; Roncon, Loris

    2017-09-09

    We investigated the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI) and medicated with ketamine or midazolam as induction agent. STEMI patients admitted between 1st January 2009 and 1st January 2017 who did not receive any type of inotropic support before the endotracheal intubation (ETI) was reviewed. PIH was defined as a reduction greater than 20% or a drop of systolic blood pressure (SBP) below 90 mmHg within 10 min from the administration of the induction agent [ketamine (1 mg/kg) or midazolam (0.3 mg/kg)]. Over the study period, 136 patients (66 male and 70 females, mean age 72.25 ± 7.33 years) met the inclusion criteria. Patients treated with midazolam and ketamine were 63 and 73, respectively. PIH was observed in 38 (27.9%) patients after 10 min from ETI. Midazolam patients had a significant lower SBP at both 5 and 10 min after induction (97.75 ± 8.06 vs 100.81 ± 8.08, p = 0.029 and 92.83 ± 7.53 vs 101.58 ± 7.29, p predictors of PIH in STEMI patients treated with midazolam, as induction agent, before ETI. Midazolam was more likely than ketamine to cause significant PIH when used as an induction agent for RSI in hemodynamically stable patients with STEMI.

  20. Comparative evaluation of oral clonidine and midazolam as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anaesthesia

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    Anjan Das

    2013-07-01

    Full Text Available Context: Laryngoscopy and endotracheal intubation is associated detrimental hemodynamic changes like rise in blood pressure (BP, heart rate (HR leading to adverse cardiological outcome specially in susceptible individuals. Aims: To compare the blood pressure (BP and heart rate (HR changes during laryngoscopy and endotracheal intubation as well as to evaluate the preoperative sedation status between oral clonidine and oral midazolam as premedication for the patients undergoing general anesthesia (GA. Settings and Design: Fifty patients between 18 and 60 years of age of either sex of American Society of Anesthesiologists (ASA Grade I and II undergoing GA were randomly divided into two equal groups of 25 patients each. Group-C patients received clonidine 4 mcg/kg orally and Group-M patients received 0.5 mg/kg midazolam orally as premedication. Material s and Methods: After measuring baseline hemodynamic parameters patients of both groups received premedication. Preoperative sedation was assessed 2 hr after premedication administration. Standard anesthetic technique was followed. Hemodynamic (HR, BP parameters were noted baseline, immediately after laryngoscopy and intubation and 5 min after intubation to observe the stress response. Results and Statistical Analysis: A significant difference in pre-operative sedation between two groups (P < 0.05 and midazolam (group M produced significantly better sedation than clonidine (group C. Laryngoscopic stress response in group C was still at a lower level than baseline values and significantly (P < 0.005 less than group M. Conclusions: Oral midazolam is more effective in producing preoperative sedation than oral clonidine while on the contrary oral clonidine is more efficacious in reducing laryngoscopic stress response than oral midazolam. Laryngoscopy and intubation was better controlled by oral clonidine than midazolam.

  1. Effect of Intranasal Sedation Using Ketamine and Midazolam on Behavior of 3-6 Year-Old Uncooperative Children in Dental Office: A Clinical Trial

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    Majid Mehran

    2017-02-01

    Full Text Available Objectives: The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments.  Materials and Methods: In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg or midazolam (0.2mg/kg prior to treatment. The other medication was used in the next visit. The children’s behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA.Results: The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002; movement of children decreased with fewer incidence of treatment interruption (P=0.001 while their sleepiness increased (P=0.003. Despite higher success of sedation with ketamine compared to midazolam, no significant differences were found between the two regarding patients’ overall behavior (P>0.05. The patients had higher heart rate and blood pressure with ketamine; however, no significant difference was found regarding respiratory rate and oxygen saturation (P>0.05.  Conclusions: Ketamine (0.5mg/kg led to fewer movements, less crying and more sleepiness compared to midazolam (0.2mg/kg. No significant differences were found between the two drugs regarding children’s overall behavior and sedation efficiency. Both drugs demonstrated positive efficacy for sedation of children during dental treatments.Keywords: Conscious Sedation; Ketamine; Midazolam; Administration, Intranasal

  2. Clinical Study of Midazolam in Treatment of Status Epilepticus%咪达唑仑治疗癫痫持续状态的临床研究

    Institute of Scientific and Technical Information of China (English)

    张建磊; 王朝辉; 李郭飞; 常娜; 刘大建; 贺维亚

    2014-01-01

    Objective:To investigate the efficiency of midazolam in treatment of status epilepticus. Method:52 patients with status epilepticus(from January 2012 to January 2014)were randomly divided into control group and midazolam group,the former were given conventional treatment and diazepam,while midazolam group were given conventional treatment and midazolam. Result:The total effective rate of midazolam group was 92.3%;the total effective rate of the control group was 80.7%,the difference was statistically significant(P0.05). Conclusion:Midazolam is safe,effective and rapid onset in treatment of status epilepticus.%目的:探讨咪达唑仑治疗癫痫持续状态的临床效果。方法:选取本院2012年1月-2014年1月收治的癫痫持续状态患者52例,随机分为对照组和咪达唑林组,给予常规治疗的同时,咪达唑仑组给予咪达唑仑,对照组采用地西泮控制癫痫持续状态。结果:咪达唑仑组的总有效率为92.3%,对照组的总有效率为80.7%,两组总有效率比较差异有统计学意义(P0.05)。结论:咪达唑仑用于治疗癫痫持续状态起效快、疗效好、安全。

  3. Bispectral index score and observer′s assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol

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    Dipanjan Bagchi

    2013-01-01

    Full Text Available Background: Correlation between the clinical and electroencephalogram-based monitoring has been documented sporadically during the onset of sedation. Propofol and midazolam have been studied individually using the observer′s assessment of awareness/sedation (OAA/S score and Bispectral index score (BIS. The present study was designed to compare the time to onset of sedation for propofol and midazolam using both BIS and OAA/S scores, and to find out any correlation. Methods: A total of 46 patients (18-60 years, either sex, American Society of Anesthesiologists (ASA I/II posted for infraumbilical surgeries under spinal anaesthesia were randomly allocated to receive either injection propofol 1 mg/kg bolus followed by infusion 3 mg/kg/h (Group P, n=23 or injection midazolam 0.05 mg/kg bolus followed by infusion 0.06 mg/kg/h (Group M, n=23. Spinal anaesthesia was given with 2.5 ml to 3.0 ml of 0.5% bupivacaine heavy. When sensory block reached T6 level, sedation was initiated. The time to reach BIS score 70 and time to achieve OAA/S score 3 from the start of study drug were noted. OAA/S score at BIS score 70 was noted. Data from 43 patients were analyzed using SPSS 12 for Windows. Results: Time to reach BIS score 70 using propofol was significantly lower than using the midazolam (P<0.05. Time to achieve OAA/S score 3 using propofol was comparable with midazolam (P=0.358. Conclusion: A divergence exists between the time to reach BIS score 70 and time to achieve OAA/S score 3 using midazolam, compared with propofol, during the onset of sedation.

  4. Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

    Science.gov (United States)

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists. PMID:23940729

  5. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

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    Valérie Collado

    Full Text Available The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID compared to dentally anxious patients (DA. Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale, and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS. 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test. Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test. Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test. Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions and were less often relaxed after induction (58.9% ID vs. 90.3% DA and during dental treatment (39.5% ID vs. 59.7% DA (p<0.001, Fisher exact test than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂, were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  6. A clinical investigation of the relationship between different sedation depths and the restlessness after using midazolam as an adjuvant during regional anesthesia

    Institute of Scientific and Technical Information of China (English)

    Cunming Liu; Guolou Zhang; Mei Gao; Zhongyun Wang; Qianqing Wang; Chuanbao Han; Xiufeng Hao

    2006-01-01

    Objective: To investigate the relationship between different sedation depth and the restlessness after using midazolam as an adjuvant during regional anesthesia. Methods: One hundred and fifty patients undergoing regional anesthesia were randomly divided into three groups. In group A, the patients were sedated at the level of OAA/S Ⅳ with midazolam during regional anesthesia. In group B and C, the sedation depths were kept at the levels of Ⅲ and Ⅱ respectively. The changes of BP, HR and SpO2 were recorded before and after midazolam.The rate of restlessness was also evaluated. Results: Blood pressures decreased in certain degree at 5 and 10 min after midazolam compared with those before in all three groups. BP decreased over 20% of the baseline in 4 cases in group A, in 5 cases in group B, and in 5 cases in group C. There was no significant difference in BP dropping among three groups. Compared with group B and C SpO2 dropped significantly at 3 and 5 min after midazolam in group C, in which SpO2 was less than 93% in 8 cases. The restlessness rate in group C was 22%, which was significantly higher than those in group A (2% ,P<0.01) and group B(4% ,P<0.05). Conclusion: The sedation depth is related to the rate of restlessness when midazolam is used as an adjuvant during regional anesthesia. It is suggested that the appropriate sedation depth for the patients under regional anesthesia is OAA/S Ⅲ.

  7. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

    Science.gov (United States)

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  8. Midazolam ameliorates the behavior deficits of a rat posttraumatic stress disorder model through dual 18 kDa translocator protein and central benzodiazepine receptor and neurosteroidogenesis.

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    Yu-Liang Miao

    Full Text Available Post-traumatic stress disorder (PTSD is a debilitating anxiety disorder that may develop after an individual has experienced or witnessed a severe traumatic event. It has been shown that the 18 kDa translocator protein (TSPO may be correlated with PTSD and that the TSPO ligand improved the behavioral deficits in a mouse model of PTSD. Midazolam, a ligand for TSPO and central benzodiazepine receptor (CBR, induces anxiolytic- and anti-depressant-like effects in animal models. The present study aimed to determine whether midazolam ameliorates PTSD behavior in rats as assessed by the single prolonged stress (SPS model. The SPS rats received daily Sertraline (Ser (15 mg/kg, i.p. [corrected] and midazolam (0.125, 0.25, 0.5, and 1 mg/kg, i.p. [corrected] during the exposure to SPS and behavioral assessments, which included the open field (OF test, the contextual fear paradigm (CFP, and the elevated plus-maze (EPM. The results showed that, like Ser (15 mg/kg, i.p. [corrected], midazolam (0.25 and 0.5 mg/kg, i.p. [corrected] significantly reversed the behavioral deficiencies of the SPS rats, including PTSD-associated freezing and anxiety-like behavior but not the effects on spontaneous locomotor activity. In addition, the anti-PTSD effects of midazolam (0.5 mg/kg, i.p. [corrected] were antagonized by the TSPO antagonist PK11195 (3 mg/kg, i.p., the CBR antagonist flumazenil (15 mg/kg, i.p. [corrected] and the inhibitor of steroidogenic enzymes finasteride (30 mg/kg, i.p. [corrected], which by themselves had no effect on PTSD-associated freezing and anxiety-like behavior. In summary, this study demonstrated that midazolam improves the behavioral deficits in the SPS model through dual TSPO and CBR and neurosteroidogenesis.

  9. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study.

    Science.gov (United States)

    Shtull-Leber, Eytan; Silbergleit, Robert; Meurer, William J

    2017-01-01

    Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17-1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent with trial data, which should encourage

  10. Midazolam Ameliorates the Behavior Deficits of a Rat Posttraumatic Stress Disorder Model through Dual 18 kDa Translocator Protein and Central Benzodiazepine Receptor and Neurosteroidogenesis

    Science.gov (United States)

    Fang, Wei-Wu; Liu, Yan; Liu, Ji; Li, Bao-Wei; Wu, Wei; Li, Yun-Feng

    2014-01-01

    Post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may develop after an individual has experienced or witnessed a severe traumatic event. It has been shown that the 18 kDa translocator protein (TSPO) may be correlated with PTSD and that the TSPO ligand improved the behavioral deficits in a mouse model of PTSD. Midazolam, a ligand for TSPO and central benzodiazepine receptor (CBR), induces anxiolytic- and anti-depressant-like effects in animal models. The present study aimed to determine whether midazolam ameliorates PTSD behavior in rats as assessed by the single prolonged stress (SPS) model. The SPS rats received daily Sertraline (Ser) (15 mg/kg, p.o.) and midazolam (0.125, 0.25, 0.5, and 1 mg/kg, p.o.) during the exposure to SPS and behavioral assessments, which included the open field (OF) test, the contextual fear paradigm (CFP), and the elevated plus-maze (EPM). The results showed that, like Ser (15 mg/kg, p.o.), midazolam (0.25 and 0.5 mg/kg, p.o.) significantly reversed the behavioral deficiencies of the SPS rats, including PTSD-associated freezing and anxiety-like behavior but not the effects on spontaneous locomotor activity. In addition, the anti-PTSD effects of midazolam (0.5 mg/kg, p.o.) were antagonized by the TSPO antagonist PK11195 (3 mg/kg, i.p.), the CBR antagonist flumazenil (15 mg/kg, p.o.) and the inhibitor of steroidogenic enzymes finasteride (30 mg/kg, p.o.), which by themselves had no effect on PTSD-associated freezing and anxiety-like behavior. In summary, this study demonstrated that midazolam improves the behavioral deficits in the SPS model through dual TSPO and CBR and neurosteroidogenesis. PMID:24988461

  11. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study

    Science.gov (United States)

    Silbergleit, Robert

    2017-01-01

    Background Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. Methods and findings This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17–1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. Conclusions These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent

  12. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Xing Lu; Jun Li; Tong Li; Jie Zhang; Zhi-Bo Li; Xin-Jing Gao; Lei Xu

    2016-01-01

    Purpose:To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU.Methods:This randomized,prospective study was conducted in Tianjin Third Central Hospital,China.Using a sealed-envelope method,the patients were randomly divided into 2 groups (40 patients per group).Each patient of group A received an initial loading dose of midazolam at 0.3-3 mg/kg·h 24 h before extubation,followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation.Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation.The dose of sedation was regulated according to RASS sedative scores maintaining in the range of-2-1.All patients were continuously monitored for 60 min after extubation.During the course,heart rate (HR),mean artery pressure (MAP),extubation time,adverse reactions,ICU stay,and hospital stay were observed and recorded continuously at the following time points:24 h before extubation (T1),12 h before extubation (T2),extubation (T3),30 min after extubation (T4),60 min after extubation (T5).Results:Both groups reached the goal of sedation needed for ICU patients.Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam,reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)),respectively (p =0.017).There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam.In the group A,HR was not significantly increased after extubation;however,in the group B,HR was significantly increased compared with the preextubation values (p < 0.05).HR was significantly higher in the group B compared with the group A at 30 and 60 main after extubation (both,p < 0.05).Compared with preextubation values,MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3,T4,T5 in the group B than group A (p < 0

  13. Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial

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    Mehrdad Esmailian

    2015-01-01

    Full Text Available Background: Restless and violent behaviors are common in Emergency Departments (EDs, which need therapeutic interventions in most of the times. The first-generation anti-psychotic drugs are one of the most applicable therapeutic agents in the management of such patients, but their use has some limitations. Some studies suggest midazolam as an alternative medicine. Therefore, this study was performed with the aim of comparison of the efficacy and safety of haloperidol and midazolam in the restless management of referring patients to EDs. Materials and Methods: The present double-blinded trial was done on patients needed sedation and referred to the ED of Alzahra Hospital, Isfahan, Iran, in 2014. The patients were categorized into two random groups of haloperidol (5 mg and midazolam receivers (2.5 mg for those weighing 50 kg, as intramuscular administration. The time to achieve sedation, need for rescue dose, need to resedation within the first 60 min, and adverse effects of drugs were compared among the groups. Results: Forty-eight patients were entered to the study. The mean age in the haloperidol and midazolam groups was 44.8 ± 4.1 years and 45.5 ± 4.7 years, respectively (P = 0.91. The mean time of sedation in the haloperidol and midazolam groups was 5.6 ± 0.3 min and 5.2 ± 0.1 min, respectively (P = 0.31. The mean time of full consciousness after sedation was 36.2 ± 4.5 min and 38.2 ± 3.4 min in the haloperidol and midazolam groups, respectively (P = 0.72. On average, time to arousal in the midazolam group was 10.33 min more than the haloperidol group, but it was not statistically significant. Conclusion: The results of the present study show that administration of midazolam and haloperidol have similar efficacy in the treatment of restless symptoms with the same recovery time from drug effects for referring patients to the ED. In addition, none of the adverse effects were observed in this study.

  14. Midazolam Inhibits the Apoptosis of Astrocytes Induced by Oxygen Glucose Deprivation via Targeting JAK2-STAT3 Signaling Pathway

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    Li Liu

    2015-01-01

    Full Text Available Background: There is an increasing interest in the role of astrocytes contributing to the intrinsic bioremediation of ischemic brain injury. The purpose of this study was to disclose the effects and mechanism of midazolam (MDZ on the proliferation and apoptosis of astrocytes under oxygen glucose deprivation (OGD condition. Methods: The astrocytes were assigned randomly into four groups: control group, OGD group, OGD+MDZ group, and OGD+MDZ+IL-6 group. The astrocytes were treated with MDZ at dose of 10 μmol/L in OGD+MDZ group. And in OGD+MDZ+IL-6 group, the astrocytes were treated with MDZ at dose of 10μmol/L and IL-6 at dose of 50 ng/mL. MTT assay was used to assess cell proliferation, and cell apoptosis was analyzed by TUNEL apoptosis assay kit and flow cytometry. Furthermore, the expression of JAK2, p-JAK2, STAT3, p-STAT3, Bcl-2, Bax and Caspase-3 proteins were determined by western blotting assay. Results: Astrocytes proliferation was decreased obviously in OGD group, while MDZ could increase astrocytes proliferation under OGD condition. Moreover, OGD could induce apoptosis in astrocytes and MDZ could play an anti-apoptotic role. However, IL-6, a JAK2 activator, could attenuate cell proliferation and anti-apoptotic effects of MDZ in astrocytes. In addition, the expression of Bcl-2 protein in MDZ group increased markedly, while the JAK2/STAT3 signal proteins, Bax and Caspase-3 proteins decreased relative to OGD group. But IL-6 could counteract the anti-apoptotic effects of MDZ. Conclusion: Midazolam has protective effects on the proliferation and apoptosis of astrocytes via JAK2/STAT3 signal pathway in vitro. We firstly disclose the beneficial roles of midazolam in astrocytes under ischemic condition, which may be a rational treatment selection for ischemic cerebral protection.

  15. Propofol-alfentanyl versus midazolam-ketamine for sedation and analgesia during bone marrow spiration in children

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    Darabi M.A

    2007-09-01

    Full Text Available Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharmacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.Methods: Fifty children with oncologic malignancies whose ages ranged between 2-12 years were enrolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001. After Midazolam- Ketamine sedation, a statistically significant inc