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J Clin Anesth. 2001 Jun;13(4):277-80.

A small dose of midazolam decreases the time to achieve hypnosis without delaying emergence during short-term propofol anesthesia.

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  • 1Department of Anesthesiology, National Defense Medical College, 3-2 Namiki Tokorozawa city, Saitama, 359-8513, Japan. grd1117@gr.ndmc.ac.jp

Abstract

STUDY OBJECTIVE:

To evaluate the effect of a small dose of midazolam (10 microg kg(-1)) on induction and emergence during short-term propofol anesthesia and to investigate the effects of subsequent administration of flumazenil.

DESIGN:

Double-blinded, prospective, randomized study.

SETTING:

Operating room of a medical college hospital.

PATIENTS:

30 male ASA physical status I and II patients (ages 51 to 75) scheduled for minor surgery under spinal anesthesia.

INTERVENTIONS:

Patients were randomly allocated to one of three groups: the placebo-propofol-placebo (PP) group, the midazolam-propofol-placebo (MP) group, or the midazolam-propofol-flumazenil (MF) group. After administering placebo or midazolam (10 microg kg(-1)), propofol 250 microg kg(-1) min(-1) was infused. Immediately after confirming that the patient was hypnotized, we terminated the propofol infusion and administered placebo or flumazenil (5 microg kg(-1)).

MEASUREMENTS:

The dose and the times required to achieve hypnosis (the first endpoint) and to emerge from anesthesia (the second endpoint). The plasma concentration at each endpoint was determined.

MAIN RESULTS:

Midazolam significantly decreased the dose and time needed to achieve hypnosis [PP vs. MP, 66 +/- 14 vs. 48 +/- 15 mg, 260 +/- 55 vs. 179 +/- 44 sec, respectively (mean +/- SD)]. Thus, the plasma concentration of propofol at hypnosis was significantly lower (PP vs. MP, 3.31 +/- 0.78 vs. 2.41 +/- 0.57 microg mL(-1)). The time to emerge from anesthesia was not prolonged by midazolam, and was further shortened by administration of flumazenil (PP, MP vs. MF, 237 +/- 77, 207 +/- 71 s vs. 126 +/- 56 sec, respectively). Flumazenil also reversed the reduction in propofol concentration induced by midazolam at emergence (PP, MP, and MF, 0.54 +/- 0.17, 0.37 +/- 0.15, and 0.59 +/- 0.22 microg mL(-1), respectively).

CONCLUSIONS:

Coadministration of 10 microg kg(-1)midazolam decreases the dose and time required to achieve hypnosis with propofol induction without delaying emergence from anesthesia. Additional administration of flumazenil further shortens the time to emerge from midazolam-propofol anesthesia.

PMID:
11435052
[PubMed - indexed for MEDLINE]
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