Midazolam--does it cause resedation?

Effects of Intravenous Midazolam and Diazepam on Patient Response, Percentage of Oxygen Saturation, and Hemodynamic Factors During Periodontal Surgery

BACKGROUND

The purpose of this double-masked study was to evaluate effects of intravenous sedation (IVS) using midazolam or diazepam during periodontal procedures on patient recall, psychomotor response, oxygen saturation, and hemodynamic factors.

METHODS

Seventeen patients received either two or three scheduled periodontal surgeries under IVS with midazolam, diazepam, or placebo control. Patients were monitored throughout the procedure for hemodynamic variables, percent oxygen saturation, level of recall of common objects presented at baseline, and psychomotor function via the perceptual speed test (PST).

RESULTS

Fifteen patients completed the study with average titrated dosages of 3.3 and 12.1 mg for midazolam and diazepam, respectively. Within the limitations of the study, there were few differences observed between the drugs with regard to hemodynamic variables, oxygen saturation, and overall percentage of objects recalled by patients sedated with either drug. However, midazolam was found to cause a greater incidence of amnesia lasting up to 30 minutes when compared to placebo. Patients on diazepam required an average of 15 minutes longer to recover accuracy as measured by the PST.

CONCLUSIONS

The results suggest that diazepam and midazolam each may have advantages for IVS. In procedures lasting over 45 minutes, diazepam appears to be more clinically advantageous including a wider margin of safety during titration and gradual recovery. Midazolam may be used for shorter procedures for faster onset of action, predictable amnesic effects, and relatively rapid recovery.

Midazolam combined with paracervical blockade compared to general anaesthesia for curettage of the uterus

Two anaesthetic techniques were compared in a randomized trial of 60 ASA I and II women admitted for diagnostic dilatation and curettage of the uterus. Group I had fentanyl 2.5 micrograms/kg and thiopentone 2 mg/kg i.v. Supplementary thiopentone 50 mg was given every 15 s until loss of the eyelid reflex. Anaesthesia was maintained with nitrous oxide in oxygen 2/1 together with supplementary thiopentone 50 mg as required. Group II had midazolam 0.1 mg/kg i.v. and a supplementary 0.025 mg/kg every second min until sleep or dysarthria, followed by paracervical blockade with 1% mepivacaine 10 ml on each side of the portio. There was no significant depression of the cardiovascular system. The working conditions for the gynaecologist were good in both groups. The midazolam technique gave just as good amnesia as did general anaesthesia, and there was a high degree of patient satisfaction in both groups. In the thiopentone group there was a significant depression of the respiratory rate and a significantly higher frequency of adverse effects (nausea and vomiting) as compared to the midazolam group. It is concluded that paracervical blockade combined with midazolam, titrated i.v., until sleep or dysarthria, is a recommendable anaesthetic technique for diagnostic dilatation and curettage.

Midazolam in conservative dentistry. A cross-over trial

In a double-blind trial, 50 patients were randomly allocated to receive up to 0.29 mg/kg diazepam (Valium 5 mg/ml) or 0.14 mg/kg of midazolam (midazolam hydrochloride 5 mg/ml) intravenously at a first session of conservative dentistry, the alternative being administered at the second session. Good operating conditions were reported under each sedative and no important physiological differences were observed. Most patients failed to return to 'street fitness' 30 minutes after either session of treatment. Previous reports of reduced incidence of venous thrombophlebitis with midazolam were not convincingly confirmed in this trial, but data quality was poor. For about half the patients, the amnesic effect was stronger following midazolam.