Analgesia-sedation for day-case inguinal hernia repair

The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpremedicated and underwent herniorrhaphy using a Bassini repair technique with a standard local anaesthetic block. Sedation was obtained with titrated intravenous midazolam (Hypnovel, Roche Products Ltd.) without narcotic analgesia. Patients were evaluated with a simple questionnaire after surgery. The maximum dose of midazolam used was 5 mg (median dose 3.5 mg). Monitoring of vital signs with pulse oximetry during the operative period was routine though oxygen therapy was not required. All patients were able to walk without assistance and were discharged under responsible supervision. Operative morbidity was low (5 percent). Adverse reactions to the procedure such as nausea, vomitting and headache were not seen. In conclusion, conscious sedation allows amnesia to be achieved with low morbidity in the majority of patients undergoing local anaesthetic procedures. This should result in increased patient acceptance.(AU)

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)

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)