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1.
Int J Oral Maxillofac Implants ; 36(6): e159-e165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34919613

RESUMO

PURPOSE: Conscious sedation in oral surgical procedures provides comfort both for patients and practitioners. Midazolam is a sedative agent commonly used in this manner. Dexmedetomidine is also a decent sedative agent, with its analgesic and mild respiratory effects, which is usually preferred in intensive care units. Dexmedetomidine has been recently used in dental surgeries. This study aimed to investigate the analgesic and respiratory properties of midazolam and dexmedetomidine in conscious sedation during dental implant procedures and to compare these two drugs in terms of ease of use and comfort of dental implant operation. MATERIALS AND METHODS: This study was a prospective double-blind randomized controlled study. The patients who needed dental implant placement were divided into two randomized groups for either midazolam or dexmedetomidine. The amount of sedative agent used, duration of the procedure, onset of sedation, use of additional same sedative agent, and occurrence of desaturation were recorded. Hemodynamic and respiratory variables (mean blood pressure, heart rate, oxygen saturation, and respiratory rate) were recorded every 10 minutes, starting immediately before the loading dose until the end of the procedure. Patients completed a Likert scale for their satisfaction, and patient pain was scored using the numeric rating scale postoperatively. The amount of painkiller usage was recorded and reported. All surgical procedures were performed by the same surgeon, and all recordings were taken by an anesthesiology technician; both were blinded for the randomization. Descriptive and bivariate statistics were computed, and the P value was set at < .05. RESULTS: This study included patients who were scheduled for two to five dental implant insertions to either arch under conscious sedation. A total of 163 dental implants were inserted into 43 patients. Patients receiving dexmedetomidine had lower pain, higher satisfaction with the procedure, and less desaturation (P = .002). The onset of sedation was more rapid with midazolam (P = .001). The number of implants according to drugs did not differ statistically. On the other hand, the mean operation time was 52.09 ± 20.12 minutes in the dexmedetomidine group and 87.14 ± 26.15 minutes in the midazolam group (P = .001). No significant difference was found for retrograde amnesia and preference of sedative between midazolam and dexmedetomidine. CONCLUSION: Dexmedetomidine is a good alternative to midazolam for conscious sedation during dental implant procedures, with its better analgesic property and minimal respiratory side effects.


Assuntos
Implantes Dentários , Dexmedetomidina , Sedação Consciente/efeitos adversos , Implantes Dentários/efeitos adversos , Dexmedetomidina/efeitos adversos , Humanos , Midazolam/efeitos adversos , Estudos Prospectivos
2.
A A Pract ; 15(11): e01547, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34807869

RESUMO

Hiccups are a common phenomenon experienced by many people and are usually short-lived with spontaneous resolution of symptoms. Certain anesthetic medications have been associated with the development of hiccups, though the underlying pathophysiology and reflex arcs remain poorly understood. We describe a patient who developed hiccups lasting 9 days following an orthopedic surgery and again developed hiccups during a subsequent surgery after only having received midazolam; flumazenil administration led to sustained cessation of his hiccup symptoms immediately.


Assuntos
Soluço , Flumazenil/uso terapêutico , Soluço/induzido quimicamente , Soluço/tratamento farmacológico , Humanos , Midazolam/efeitos adversos
3.
J Indian Soc Pedod Prev Dent ; 39(3): 233-239, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810337

RESUMO

Background: Pain, fear, and anxiety have long been associated with pediatric dentistry. A child's cooperation with a dental.procedure.usually requires various behavioral management strategies conveyed by the entire dental team. The use of sedatives in dental clinics for providing analgesia and anxiolysis allows the patient to respond appropriately to verbal commands and light tactile stimulation., thus making dental treatment more patient friendly and effective. Aim: The aim of this study was to compare the safety and efficacy of dexmedetomidine versus midazolam for the management of pediatric patients in the dental clinic. Materials and Methods: This systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six articles were selected for this systematic review. Of them, only in four articles, homogeneous data were available which were subjected to meta-analysis. Results: When compared with midazolam, premedication with dexmedetomidine resulted in much lower incidence of emergence delirium (odds ratio = 0.07, 95% confidence interval: 0.01-0.54, P = 0.01). No significant difference was observed with respect to satisfactory behavior of the child, successful parental separation, and satisfactory mask acceptance following sedation. Conclusion: Both dexmedetomidine and midazolam are equally effective for the management of pediatric patients in the dental clinic. In addition, dexmedetomidine premedication is associated with lower incidence of emergence delirium and has a better margin of safety.


Assuntos
Dexmedetomidina , Midazolam , Criança , Dexmedetomidina/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Pré-Medicação
4.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34610948

RESUMO

BACKGROUND: Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine's effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations. We implemented a quality improvement initiative with the aim of decreasing midazolam infusions by 20% through use of dexmedetomidine. METHODS: A multidisciplinary committee created a sedation guideline that included standardized dexmedetomidine dosing escalation and weaning. Baseline data collection occurred from January 2015 to February 2018, with intervention from March 2018 to December 2019. Percentage of sedation episodes with dexmedetomidine initiated was followed as a process measure. Outcomes measures were percentage of eligible infants receiving midazolam infusions and midazolam-free days per sedation episode. Bradycardia with dexmedetomidine, unplanned extubation rates, and morphine dosage were monitored as balancing measures. RESULTS: Our study included 434 episodes of sedation in 386 patients. Dexmedetomidine initiation increased from 18% to 49%. The intervention was associated with a significant reduction in midazolam initiation by 30%, from 95% to 65%, with special cause variation on statistical process control chart analysis. Midazolam-free days per sedation episode increased from 0.3 to 2.2 days, and patients receiving dexmedetomidine had lower midazolam doses (1.3 mg/kg per day versus 2.2 mg/kg per day, P = 5.97 × 10-04). Bradycardia requiring discontinuation of dexmedetomidine, unplanned extubation rates, and morphine doses were unchanged. CONCLUSIONS: Implementation of a quality improvement initiative was successful in reducing the percentage of patients receiving midazolam infusions and increased midazolam-free days per sedation episode, revealing an overall reduction in benzodiazepine exposure while maintaining adequate sedation.


Assuntos
Dexmedetomidina/administração & dosagem , Substituição de Medicamentos , Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Extubação , Analgésicos Opioides/administração & dosagem , Bradicardia/induzido quimicamente , Dexmedetomidina/efeitos adversos , Esquema de Medicação , Idade Gestacional , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/induzido quimicamente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Midazolam/efeitos adversos , Morfina/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade , Fatores de Tempo
5.
Rev Med Chil ; 149(2): 237-241, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479268

RESUMO

BACKGROUND: Benzodiazepines are used for perioperative conscious sedation. However, its use may be associated with paradoxical reactions. The known risk factors for these reactions are age, alcohol and drug abuse and psychiatric disorders. AIM: To assess the incidence and impact of risk factors of paradoxical reactions to midazolam. MATERIAL AND METHODS: Cross sectional study of 218 patients aged 50 ± 16 years (51% women) scheduled for elective surgical procedures under regional anesthesia and midazolam sedation. The paradoxical reactions were classified according to their severity in three categories. RESULTS: The incidence of paradoxical reactions to midazolam was 8.3% (95% confidence interval (CI) 5.0-12.7). All were mild and only 28% of the affected patients required pharmacological treatment, none of them flumazenil. A multivariable logistic regression model showed that the variables independently associated with a paradoxical reaction to midazolam were the use of psychoactive medications (Odds Ratio (OR) = 3.4 [1.1-11], p = 0.04, and the dose of midazolam (OR 1.35 [1.03-1.78], p = 0.03. CONCLUSIONS: The incidence of paradoxical reactions to midazolam was 8,3% and all were mild. Their risk factors are the use of psychoactive medications and the use of higher doses of midazolam.


Assuntos
Sedação Consciente , Midazolam , Sedação Consciente/efeitos adversos , Estudos Transversais , Feminino , Flumazenil , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Midazolam/efeitos adversos
6.
Clin Neuropharmacol ; 44(6): 245-246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34561338

RESUMO

OBJECTIVES: The objective of this study was to report a case of sleep online shopping. METHODS: A single case study of midazolam-induced sleep online shopping behavior in a 35-year-old woman with posttraumatic stress disorder and bipolar II disorder was performed. RESULTS: The Naranjo score was 7, which supported the probability of midazolam-induced sleep online shopping behaviors. CONCLUSIONS: To the best of our knowledge, this is the first case report of parasomnia as online-shopping behaviors, induced by midazolam, in a patient with posttraumatic stress disorder and bipolar disorder. This case could serve as a reminder for the clinicians prescribing midazolam as a hypnotic for insomnia for their patients.


Assuntos
Parassonias , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Transtornos de Estresse Pós-Traumáticos , Adulto , Feminino , Humanos , Midazolam/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
7.
Ann Ital Chir ; 92: 406-411, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524117

RESUMO

BACKGROUND: Intraoperative awareness is a serious adverse event under general anesthesia. Midazolam has a good anterograde amnesia-inducing effect, can prevent and reduce the occurrence of intraoperative awareness. However, if the dosage of midazolam is improperly controlled, it may not produce forgetting effect, or bring obvious adverse side effects, such as respiratory depression, and delay of recovery. However, the half maximal effective dose (ED50 ) of midazolam for amnesia, the duration of amnesia and the factors affecting the duration of amnesia are still inconclusive. Therefore, it is of great clinical significance to observe and determine the dose, duration and influencing factors of amnesia induced by midazolam METHODS: A total of 106 patients who underwent ASA grades I-II elective operation under spinal-epidural anesthesia were intravenously injected with different doses of midazolam at 10 minutes after spinal-epidural anesthesia, every 5 minutes, the patient was presented with pictures or sounds as memory content, and heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), blood oxygen saturation (SpO2), bispectral index (BIS), OAA/S and adverse events were recorded. The patient's forgetfulness was followed up in the early morning after operation. RESULTS: ED50 (the dose for amnesia in half of the subjects) was 0.031 mg/kg (95% CI: 0.027-0.036 mg/kg); ED95 (the dose for amnesia in 95% of the subjects) was 0.044 mg/kg (95% CI: 0.038-0.071 mg/kg). After the patients were injected intravenously with 0.04 mg/kg of midazolam, the respiratory and circulatory systems were basically stable, no serious adverse events occurred, and the forgetting rate was 88.5%. ET50 (the time for half of the subjects in a state of forgetfulness) was 23.77 minutes (95% CI: 20.18-27.07 min), and the corresponding BIS was 83.22; ET05 (the time for 5% of the subjects in a state of forgetfulness) was 53.90 minutes (95% CI: 48.54-61.47 min) and the corresponding BIS was 91.38. The amnesia-inducing effect of midazolam was correlated to sedation grade, BIS and age, and was not correlated to visual memory or auditory memory. CONCLUSION: In this study, the ED50 , ED95 and maintenance time of the forgetting effect of intravenous midazolam were preliminarily determined. KEY WORDS: Amnesia, Duration of amnesia, ED50, Midazolam.


Assuntos
Raquianestesia , Midazolam , Amnésia/induzido quimicamente , Humanos , Midazolam/efeitos adversos
8.
Cochrane Database Syst Rev ; 8: CD011786, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34397100

RESUMO

BACKGROUND: This is an updated version of a Cochrane Review published in 2017. Paediatric neurodiagnostic investigations, including brain neuroimaging and electroencephalography (EEG), play an important role in the assessment of neurodevelopmental disorders. The use of an appropriate sedative agent is important to ensure the successful completion of the neurodiagnostic procedures, particularly in children, who are usually unable to remain still throughout the procedure. OBJECTIVES: To assess the effectiveness and adverse effects of chloral hydrate as a sedative agent for non-invasive neurodiagnostic procedures in children. SEARCH METHODS: We searched the following databases on 14 May 2020, with no language restrictions: the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid, 1946 to 12 May 2020). CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, the Cochrane Central Register of Controlled Trials (CENTRAL), and the specialised registers of Cochrane Review Groups including Cochrane Epilepsy. SELECTION CRITERIA: Randomised controlled trials that assessed chloral hydrate agent against other sedative agent(s), non-drug agent(s), or placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently evaluated studies identified by the search for their eligibility, extracted data, and assessed risk of bias. Results were expressed in terms of risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, with 95% confidence intervals (CIs). MAIN RESULTS: We included 16 studies with a total of 2922 children. The methodological quality of the included studies was mixed. Blinding of the participants and personnel was not achieved in most of the included studies, and three of the 16 studies were at high risk of bias for selective reporting. Evaluation of the efficacy of the sedative agents was also underpowered, with all the comparisons performed in small studies. Fewer children who received oral chloral hydrate had sedation failure compared with oral promethazine (RR 0.11, 95% CI 0.01 to 0.82; 1 study; moderate-certainty evidence). More children who received oral chloral hydrate had sedation failure after one dose compared to intravenous pentobarbital (RR 4.33, 95% CI 1.35 to 13.89; 1 study; low-certainty evidence), but there was no clear difference after two doses (RR 3.00, 95% CI 0.33 to 27.46; 1 study; very low-certainty evidence). Children with oral chloral hydrate had more sedation failure compared with rectal sodium thiopental (RR 1.33, 95% CI 0.60 to 2.96; 1 study; moderate-certainty evidence) and music therapy (RR 17.00, 95% CI 2.37 to 122.14; 1 study; very low-certainty evidence). Sedation failure rates were similar between groups for comparisons with oral dexmedetomidine, oral hydroxyzine hydrochloride, oral midazolam and oral clonidine. Children who received oral chloral hydrate had a shorter time to adequate sedation compared with those who received oral dexmedetomidine (MD -3.86, 95% CI -5.12 to -2.6; 1 study), oral hydroxyzine hydrochloride (MD -7.5, 95% CI -7.85 to -7.15; 1 study), oral promethazine (MD -12.11, 95% CI -18.48 to -5.74; 1 study) (moderate-certainty evidence for three aforementioned outcomes), rectal midazolam (MD -95.70, 95% CI -114.51 to -76.89; 1 study), and oral clonidine (MD -37.48, 95% CI -55.97 to -18.99; 1 study) (low-certainty evidence for two aforementioned outcomes). However, children with oral chloral hydrate took longer to achieve adequate sedation when compared with intravenous pentobarbital (MD 19, 95% CI 16.61 to 21.39; 1 study; low-certainty evidence), intranasal midazolam (MD 12.83, 95% CI 7.22 to 18.44; 1 study; moderate-certainty evidence), and intranasal dexmedetomidine (MD 2.80, 95% CI 0.77 to 4.83; 1 study, moderate-certainty evidence). Children who received oral chloral hydrate appeared significantly less likely to complete neurodiagnostic procedure with child awakening when compared with rectal sodium thiopental (RR 0.95, 95% CI 0.83 to 1.09; 1 study; moderate-certainty evidence). Chloral hydrate was associated with a higher risk of the following adverse events: desaturation versus rectal sodium thiopental (RR 5.00, 95% 0.24 to 102.30; 1 study), unsteadiness versus intranasal dexmedetomidine (MD 10.21, 95% CI 0.58 to 178.52; 1 study), vomiting versus intranasal dexmedetomidine (MD 10.59, 95% CI 0.61 to 185.45; 1 study) (low-certainty evidence for aforementioned three outcomes), and crying during administration of sedation versus intranasal dexmedetomidine (MD 1.39, 95% CI 1.08 to 1.80; 1 study, moderate-certainty evidence). Chloral hydrate was associated with a lower risk of the following: diarrhoea compared with rectal sodium thiopental (RR 0.04, 95% CI 0.00 to 0.72; 1 study), lower mean diastolic blood pressure compared with sodium thiopental (MD 7.40, 95% CI 5.11 to 9.69; 1 study), drowsiness compared with oral clonidine (RR 0.44, 95% CI 0.30 to 0.64; 1 study), vertigo compared with oral clonidine (RR 0.15, 95% CI 0.01 to 2.79; 1 study) (moderate-certainty evidence for aforementioned four outcomes), and bradycardia compared with intranasal dexmedetomidine (MD 0.17, 95% CI 0.05 to 0.59; 1 study; high-certainty evidence). No other adverse events were significantly associated with chloral hydrate, although there was an increased risk of combined adverse events overall (RR 7.66, 95% CI 1.78 to 32.91; 1 study; low-certainty evidence). AUTHORS' CONCLUSIONS: The certainty of evidence for the comparisons of oral chloral hydrate against several other methods of sedation was variable. Oral chloral hydrate appears to have a lower sedation failure rate when compared with oral promethazine. Sedation failure was similar between groups for other comparisons such as oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam. Oral chloral hydrate had a higher sedation failure rate when compared with intravenous pentobarbital, rectal sodium thiopental, and music therapy. Chloral hydrate appeared to be associated with higher rates of adverse events than intranasal dexmedetomidine. However, the evidence for the outcomes for oral chloral hydrate versus intravenous pentobarbital, rectal sodium thiopental, intranasal dexmedetomidine, and music therapy was mostly of low certainty, therefore the findings should be interpreted with caution. Further research should determine the effects of oral chloral hydrate on major clinical outcomes such as successful completion of procedures, requirements for an additional sedative agent, and degree of sedation measured using validated scales, which were rarely assessed in the studies included in this review. The safety profile of chloral hydrate should be studied further, especially for major adverse effects such as oxygen desaturation.


Assuntos
Hidrato de Cloral/administração & dosagem , Técnicas de Diagnóstico Neurológico , Hipnóticos e Sedativos/administração & dosagem , Criança , Hidrato de Cloral/efeitos adversos , Humanos , Hidroxizina/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Midazolam/administração & dosagem , Midazolam/efeitos adversos , Pentobarbital/administração & dosagem
9.
J Interv Cardiol ; 2021: 9932171, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34404983

RESUMO

Objective: We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background: Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods: A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results: Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p=0.95). Conclusions: Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl's unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.


Assuntos
Cateterismo Cardíaco , Fentanila , Hipnóticos e Sedativos , Midazolam , Idoso , Cateterismo Cardíaco/efeitos adversos , Sedação Consciente/efeitos adversos , Feminino , Fentanila/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Midazolam/efeitos adversos , Pessoa de Meia-Idade
10.
Geriatr Gerontol Int ; 21(10): 887-892, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34427037

RESUMO

AIM: The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. METHODS: In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged ≥80 years (Group A) and 173 patients (193 procedures) were aged ≤65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. RESULTS: The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). CONCLUSIONS: ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int 2021; 21: 887-892.


Assuntos
Ketamina , Propofol , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Ketamina/efeitos adversos , Meperidina/efeitos adversos , Midazolam/efeitos adversos
12.
Anaesthesiol Intensive Ther ; 53(2): 146-152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34284552

RESUMO

INTRODUCTION: The aim of the study was to compare and evaluate the side effects (SEs) and sedation characteristics of synergistic sedation with doses of 0.25 µg kg-1 or 0.5 µg kg-1 intranasal (IN) sufentanil, and intravenous (IV) midazolam during propofol-based sedation in patients undergoing colonoscopy. MATERIAL AND METHODS: This was a prospective, randomized, double-blind study. The patients were randomly allocated into one of 3 groups: group I (n = 33) - sufentanil IN 0.5 µg kg-1; group II (n = 33) - sufentanil IN 0.25 µg kg-1; and group III (n = 33) - IN 0.9% NaCl ( placebo ) and IV 0.04 mg kg-1 midazolam. After 15 minutes, all patients received 0.5 mg kg-1 propofol intravenously. Cardiorespiratory side effects and sedation characteristics were compared. RESULTS: The propofol consumption in group III was significantly higher than in group I and II (P < 0.001). Spontaneous eye opening time was significantly longer in group III than in group I and II ( < 0.001). The patients in group III had significantly longer recovery times than patients in group I and II (P < 0.0001). Hypotension and bradycardia were not encountered during the study. The incidence of hypoxaemia was significantly greater in group III compared to other groups (P < 0.001). Pain control and endoscopist satisfaction was significantly better for group I and II than for group III (P < 0.001). CONCLUSIONS: Synergistic sedation can be achieved safely and effectively by the combination of propofol and IN sufentanil or IV midazolam for colonoscopy. However, IN sufentanil can be considered as a reasonable alternative to IV midazolam due to less respiratory depression, and better pain control and endoscopist satisfaction.


Assuntos
Midazolam , Propofol , Colonoscopia , Sedação Consciente , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Propofol/efeitos adversos , Estudos Prospectivos , Sufentanil/efeitos adversos
13.
J S Afr Vet Assoc ; 92(0): e1-e3, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34212736

RESUMO

Etorphine-azaperone is the most commonly used drug combination for chemical immobilisation of free-ranging white rhinoceroses, but causes several profound physiological disturbances, including muscle tremors. The addition of benzodiazepine sedatives, such as midazolam, has been proposed to reduce the muscular rigidity and tremors in immobilised rhinoceroses. Twenty-three free-ranging, sub-adult white rhinoceros bulls were darted and captured using a combination of etorphine plus either azaperone or midazolam. Skeletal muscle tremors were visually evaluated and scored by an experienced veterinarian, and tremor scores and distance run were compared between groups using the Wilcoxon rank sum test. No statistical differences were observed in tremor scores (p = 0.435) or distance run (p = 0.711) between the two groups, and no correlation between these variables was detected (r = -0.628; p = 0.807). Etorphine-midazolam was as effective as etorphine-azaperone at immobilising rhinoceroses, with animals running similar distances. Although the addition of midazolam to the etorphine did not reduce tremor scores compared to azaperone, it might have other beneficial immobilising effects in rhinoceroses, and further investigation is necessary to elucidate possible methods of reducing muscle tremoring during chemical immobilisation of rhinoceroses.


Assuntos
Azaperona/farmacologia , Etorfina/farmacologia , Midazolam/farmacologia , Perissodáctilos , Tremor/veterinária , Animais , Azaperona/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/veterinária , Etorfina/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/farmacologia , Imobilização , Midazolam/efeitos adversos , Tremor/induzido quimicamente
14.
J Oral Sci ; 63(3): 209-211, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34092775

RESUMO

Remimazolam is a new ultrashort-acting benzodiazepine with fast onset, quick recovery, and few side effects, such as hypotension and respiratory depression. It is expected to be safe and effective for a wide range of patients undergoing intravenous sedation for dental procedures. The aim of this literature review was to evaluate clinical and sedation outcomes for remimazolam, including method of administration, level of sedation at the dose required, and clinical adverse events. An electronic literature search of databases was conducted, and eight articles were selected for inclusion in this review. Onset time from drug administration to optimal sedation level was faster for remimazolam (around 1.5-6.4 min) than for midazolam. Recovery time was significantly shorter for remimazolam than for midazolam and propofol. A study comparing various doses of remimazolam with midazolam found no significant difference in safety. Comparison of a remimazolam group with a propofol group showed that incidences of hypotension (13.0% vs 42.9%, respectively) and respiratory depression (1.1% vs 6.9%, respectively) were significantly lower for remimazolam. Remimazolam appears to be an ideal sedative.


Assuntos
Benzodiazepinas , Midazolam , Benzodiazepinas/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos
15.
Medicine (Baltimore) ; 100(26): e26438, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190167

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complaint in patients following general anesthesia. Various antiemetics, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, are effective but still have limited efficacy. Therefore, combination therapy is preferable to using a single drug alone in high-risk patients. We performed a comparative study on the antiemetic effect of palonosetron, a 5-HT3 receptor antagonist, monotherapy vs palonosetron-midazolam combination therapy for the prevention of PONV. METHODS: A total of 104 female patients scheduled for breast cancer surgery were enrolled. They were randomly divided into 2 groups, a palonosetron monotherapy group (group P) and palonosetron-midazolam combination therapy group (group PM). Both groups received 0.075 mg palonosetron intravenously after induction of anesthesia. Patient-controlled analgesia (PCA) was applied according to the allocated group. Intravenous (IV)-PCA in group P consisted of fentanyl 20 µg/kg plus normal saline (total volume: 100 ml); IV-PCA in group PM consisted of fentanyl 20 µg/kg plus midazolam 4 mg plus normal saline (total volume: 100 ml). Efficacy parameters were collected during 0 to 1, 1 to 6, 6 to 24, and 24 to 48 hours postoperative time intervals. These measures included complete response (defined as no PONV and no rescue anti-emetic use) rate, incidence of PONV, sedation score, rescue antiemetic use, rescue analgesic use, and numerical rating scale (NRS) for pain. The complete response rate during the 0 to 24 hours interval was analyzed as the primary outcome. RESULTS: Although the complete response rate between 0 and 24 hours was higher in group PM (42.3% and 48.1% in group P and PM, respectively), there was no statistically significant difference (P = .55). The complete response rates in other time intervals were not different between the 2 groups as well. The sedation score and NRS score also showed no differences between the 2 groups. CONCLUSIONS: The combination therapy of palonosetron with midazolam did not lead to a greater reduction in the incidence of PONV than monotherapy in patients undergoing breast surgery and receiving IV-PCA containing fentanyl.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Neoplasias da Mama/cirurgia , Fentanila , Midazolam/administração & dosagem , Palonossetrom/administração & dosagem , Náusea e Vômito Pós-Operatórios , Anestésicos Intravenosos/administração & dosagem , Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Mastectomia/efeitos adversos , Mastectomia/métodos , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Palonossetrom/efeitos adversos , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(22): e26199, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087890

RESUMO

ABSTRACT: Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs.This was a retrospective data analysis. The sedation medications and relevant covariates, including demographic parameters, disability levels, oral health conditions, dental procedures, treatment time, and side effects, of 718 patients with special needs were collected between April 2013 and September 2014. The unfavorable side effects by sedation types were reported. Factors associated with procedure time and the sedation medications were assessed with multiple logistic regression analyses.Of 718 patients, 8 patients experienced unfavorable side effects (vomiting, sleepiness, or emotional disturbance) after the dental procedures; the rate was 0.6% in the 509 patients who received propofol only. In 209 patients who received propofol and midazolam, 2.4% experienced the side effects. Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04-2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06-1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28-3.86), men (aOR = 2.05, 95% CI: 1.41-2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21-3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13-2.39).With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.


Assuntos
Sedação Consciente/estatística & dados numéricos , Assistência Odontológica/normas , Midazolam/administração & dosagem , Propofol/administração & dosagem , Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/efeitos adversos , Administração Intravenosa , Adolescente , Adulto , Sintomas Afetivos/induzido quimicamente , Criança , Disfunção Cognitiva/complicações , Sedação Consciente/efeitos adversos , Assistência Odontológica/estatística & dados numéricos , Raspagem Dentária/estatística & dados numéricos , Combinação de Medicamentos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Retrospectivos , Sonolência , Vômito/induzido quimicamente
17.
Eur J Anaesthesiol ; 38(11): 1130-1137, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34175857

RESUMO

BACKGROUND: Pre-operative anxiety is a risk factor for emergence delirium in children and a multimodal approach including sedatives and nonpharmacological measures is the current strategy to tackle this anxiety. The efficacy of oral melatonin as a component of multimodal anxiolytic strategy to decrease emergence delirium is not well studied. OBJECTIVE: The aim of this study was to evaluate the efficacy of a multimodal anxiolytic strategy including oral melatonin or midazolam to decrease emergence delirium after sevoflurane anaesthesia. DESIGN: A randomised, double-blind, parallel arm, placebo-controlled trial. SETTING: Tertiary care teaching hospital from July 2019 till January 2020. PARTICIPANTS: Children in the age group of 3 to 8 years who received sevoflurane anaesthesia for elective ambulatory procedures. INTERVENTIONS: Children were randomised to receive oral premedication with either melatonin 0.3 mg kg-1, midazolam 0.3 mg kg-1 or honey as placebo. All the children received standardised nonpharmacological measures involving multiple techniques to allay anxiety. The anaesthetic plan was also standardised. MAIN OUTCOME MEASURES: The primary outcome was the incidence of emergence delirium as assessed by the Watcha scale in the postanaesthesia care unit. The secondary outcomes were pre-operative anxiety assessed using a modified Yale Preoperative Anxiety scale, patient compliance with mask induction using the Induction Compliance Checklist and postoperative sedation. RESULTS: Data from 132 children were analysed. Melatonin significantly reduced the incidence of emergence delirium compared to placebo: 27 vs. 50%, respectively, an absolute risk reduction of 23.3 [95% confidence interval 3.7 to 42.9), P = 0.03]. Melatonin also significantly reduced the risk of emergence delirium compared with midazolam: 27 vs. 56%, respectively, an absolute risk reduction of 29.2 (95% CI 9.5 to 48.8). The midazolam group had a similar incidence of emergence delirium as placebo. Sedation scores were similar in the three groups postoperatively. The incidence and score of pre-operative anxiety as well as the compliance with mask induction were similar in the three groups. CONCLUSIONS: A multimodal anxiolytic approach including oral melatonin, as opposed to oral midazolam, significantly reduced emergence delirium after sevoflurane anaesthesia. TRIAL REGISTRATION: CTRI/2019/06/019850 in Clinical Trial Registry of India (www.ctri.nic.in).


Assuntos
Delírio do Despertar , Melatonina , Anestesia Geral , Criança , Pré-Escolar , Método Duplo-Cego , Delírio do Despertar/diagnóstico , Delírio do Despertar/epidemiologia , Delírio do Despertar/prevenção & controle , Humanos , Melatonina/efeitos adversos , Midazolam/efeitos adversos , Estudos Prospectivos
19.
Bratisl Lek Listy ; 122(6): 386-390, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34002611

RESUMO

BACKGROUND: Sedation is an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on heart function. PURPOSE: To compare the changes in heart function, induced after sedation with either midazolam or dexmedetomidine, using cardiac magnetic resonance imaging (MRI). METHODS: A total number of 30 volunteers were randomized into two groups: 15 participants in the midazolam group (MID) and 15 participants in the dexmedetomidine group (DEX). Every participant underwent a one-session cardiac MRI before and after sedation onset. The following parameters were recorded: left and right ventricle stroke volume (Ao-vol and Pul-vol resp.) and maximum flow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). A monitor recorded values of mean blood pressure (MAP), pulse (P) and blood oxygen saturation (SpO2) in 5-minute intervals. RESULTS: Dexmedetomidine led to a statistically significant decrease in Ao-vol (p = 0.006) and Pul-vol (p = 0.003), while midazolam decreased E-diast (p = 0.019) Ao-vol (p = 0.001) and Pul-vol (p = 0.01). The late diastolic filling was not influenced by the sedation technique. CONCLUSION: Both sedation regimens worsened the systolic function of both ventricles. Midazolam moreover attenuated early diastolic filling of the left ventricle (Tab. 3, Fig. 4, Ref. 19).


Assuntos
Dexmedetomidina , Midazolam , Pressão Arterial , Dexmedetomidina/efeitos adversos , Frequência Cardíaca , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos
20.
Int J Clin Pract ; 75(11): e14402, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34037290

RESUMO

BACKGROUND: Midazolam, a short-acting benzodiazepine, has sedative, anxiolytic, amnestic and anticonvulsant effects. Given its advantages of rapid onset, short duration and low toxicity, midazolam is optimal for any procedural sedation. Midazolam is known to cause anterograde amnesia; however, the possibility of retrograde amnesia has also been raised. This prospective cohort, non-randomised study evaluated the presence and extent of retrograde amnesia induced by midazolam during caesarean delivery. METHODS: One hundred parturients scheduled for elective caesarean delivery under spinal anaesthesia were enrolled. As soon as giving birth, six picture cards were shown to the patients in 1-min intervals, and then midazolam (0.1 mg/kg) was given or not according to the patients' preference. This overall retrograde recall rate of six cards was the primary outcome of our study, which was asked by a blinded investigator. RESULTS: The overall retrograde card recall rate was lower in the midazolam group compared with the control group (77.0 ± 13.4 vs. 87.7 ± 3.9%, P < .001), especially at 1 minute before midazolam administration (58% vs. 88%, P < .001). Decreased memory trend was observed as time progressed towards midazolam administration in the midazolam group (P = .035). More patients answered 'yes' to the factitious event in the midazolam group than in the control group (26% vs. 4%, P = .004). CONCLUSION: Intravenous midazolam could cause a brief-period retrograde amnesia in visual and event memory. Moreover, there were more spurious reports of intraoperative factitious events in the midazolam group, implying that episodic memories were also affected by midazolam.


Assuntos
Amnésia Retrógrada , Midazolam , Amnésia Retrógrada/induzido quimicamente , Estudos de Coortes , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Midazolam/efeitos adversos , Gravidez , Estudos Prospectivos
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