Midazolam versus diazepam as premedication for gynaecologic laparoscopy done under local anaesthesia

A prospective randomised double blind trial was performed in 106 patients to compared the use of intravenous midazolam (mean dose 6.5 mg, range 4-9 mg) versus 10 mg diazepam, during gynaecologic laparoscopy under local anaesthesia. The parameters examined were: the ease of laparoscopy, patient tolerance, the amnesic effect and intra-operative blood pressure changes. Depth of sedation and recovery time were measured, using the Trieger test. The preoperative demographic variables and the operators ability to perform the procedures were similar in the two groups. The patients were more deeply sedated with the midazolam but the recovery time was similar. The patients tolerated the procedure better with midazolam with fewer of them describing the procedure as unpleasant (22 percent versus 53 percent) (P<0.01), fewer of them had whole body movement during th procedure (24.5 versus 54.5 percent) (P=0.009) and more of them had amnesia for the procedure (85 percent versus 36 percent) (P<0.0001). However mean blood pressure rose to hypertensive levels intra-operatively in the midazolam group but not in the diazepam group.(AU)

Status epilepticus: recent experience at the Port of Spain General Hospital, Trinidad

In this retrospective study, experience in status epilepticus (SE) over an 18-month period at the Port-of-Spain General Hospital is reported. Sixty-three episodes in 41 patients were studied. Fifty-one per cent of patients were under 10 years of age. Fifty-one per cent of patients were classified as remote symptomatic, 29 per cent idiopathic, 15 per cent acute symptomatic and 5 per cent febrile. Bolus doses of diazepam were used in 62 of 63 episodes, phenytoin in 18, diazepam infusion in 9, paraldehyde in 12 and phenobarbitone in 9. Seizures were controlled within half-hour of starting treatment in 55 episodes (87 per cent). In 3 episodes in 2 patients (5 per cent), control was poor and exceeded 18 hours. No deaths were recorded. Two neurological deficits and 8 other morbid events were recorded. Mean hospital stay was 2.9 days. No patient was ventilated or admitted to the Intensive Care Unit. Current drug therapy is highly effective in SE even in institutions where modern intensive care technology is limited. Prognosis is excellent in patients whom the underlying aetiology is benign. (AU)

Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam

Comparison of the ease of upper endoscopy, patient tolerance, and amnestic effect, using diazepam, midazolam, or no sedation, was performed on 149 patients. Midazolam and diazepam sedation produced better conditions and improved patient acceptability. Midazolam was associated with better patient tolerance, less thrombophlebitis, and more amnesia than diazepam, but shared a similar recovery time. Midazolam should replace diazepam as the drug of choice in those patients requiring sedation for upper endoscopy. (AU)

The treatment of tetanus in a rural community

It is suggested on the basis of personal experience of 13 cases of tetanus that diazepam is the present drug choice in the treatment of tetanus in country hospitals, where the nursing staff is insufficent and inadequately trained, and up-to-date equipment is not available (AU)