胸阻抗法监测咪唑安定及丙泊酚静脉全麻诱导过程中血流动力学变化

目的研究丙泊酚及咪唑安定静脉全麻诱导过程中对病人血流动力学变化的影响。方法年龄18~65岁、ASAⅠ或Ⅱ级的择期手术病人50例,随机分成丙泊酚组(A组)和咪唑安定组(B组),每组25例,分别以丙泊酚1.5mg/kg或咪唑安定0.2mg/kg进行诱导,用胸阻抗法监测麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)时的体循环阻力(SVR)、左心作功(LCW)、心排血量(CO)、心脏指数(CI)、SBP、DBP和HR的变化。结果两组病人在全麻诱导过程中SBP、SVR、CO、LCW差异无统计学意义,B组HR在T1、T2、T4及T5时明显快于A组(P<0.05或P<0.01)。结论0.2mg/kg咪唑安定与1.5mg/kg丙泊酚进行全麻诱导对血流动力学的影响基本一致。     

咪唑安定诱导对心脏瓣膜置换手术病人血流动力学的影响

１７例风湿性心脏病瓣膜置换术手同人，静注咪唑安定０．５ｍｇ／ｋｇ诱导，并以Ｓｗａｍ－Ｇａｎｚ导管测定血流动力学变化。ＭＡＰ、ＨＲ、ＣＩ、ＭＰＡＰ、ＰＣＷＰ、ＬＶＳＷＩ及ＲＶＳＷＩ均在诱导后明显下降，而ＲＡＰ、ＳＩ、ＳＶＲＩ及ＰＶＲＩ无明显变化，气管插ＭＡＰ、ＳＶＲＩ、ＰＶＲＩ增高。     

咪唑安定作为术前用药的临床观察

本实验按照随机双盲法,观察了咪唑安定、安定和安慰剂的术前用药效果,现报告如下。资料与方法腰麻下行下肢手术的ＡＳＡⅠ～Ⅱ级病人58例,年龄18～55岁,术前两天及术中使用过镇静剂的病人排除在外。随机将病人分为对照组(Ｃ,ｎ=16)、安定组(Ｄ,ｎ=20)和咪唑安定组(Ｍ,ｎ=22),按照双盲原则,于术前分别肌注生理盐水2ｍｌ、安定02ｍｇ/ｋｇ和咪唑安定006ｍｇ/ｋｇ,整个实验由同一医师评分。镇静程度根据ＯＡＡ/Ｃ(警觉/镇静)评分法,将清醒至深睡分为从5～1五个级别。采用100ｍｍ线记分法评估焦虑状态,从无焦虑到最大焦虑分为0～25、26～50、51…     

气管插管有关问题 咪唑安定在全麻诱导气管插管期间血流动力学变化的观察

本文采用无创心功能自动检测仪观察咪唑安定全麻诱导气管插管期间血流动力学变化,并与硫喷妥钠比较。15例病人随机分为两组,均先静注哌替啶50mg、异丙嗪25mg,I组静注咪唑安定0.3mg/kg,潘库溴铵0.1mg/kg,Ⅱ组静注硫喷妥钠5mg/kg、潘库溴铵0.1mg/kg。结果表明,咪唑安定可以增加心排血量,轻度减轻后负荷,不影响心肌收缩力和前负荷。故对缺血性心脏病、低心排血量的患者全麻诱导时,咪唑安定较硫喷妥钠安全可靠。对气管插管反应,咪唑安定仍不能有效的防止,但较硫喷妥钠反应轻微。     

咪唑安定对丙泊酚诱导需要量的影响

目的　评估咪唑安定预先给药对减少丙泊酚需要量的影响。方法　ASAⅠ～Ⅱ择期手术病人 1 2 0例 ,随机分为丙泊酚组 (A组 )、咪唑安定 0 0 4mg/kg +丙泊酚组 (B组 )和咪唑安定 0 0 6mg/kg +丙泊酚组 (C组 ) ,按丙泊酚剂量每组又分为 4个亚组 :A组分为 0 75、1 1 3、1 6 8和 2 5mg/kg 4个亚组 ;B和C组均分为 0 33、0 5、0 75和 1 1 3mg/kg 4个亚组。A组直接静注丙泊酚 ,B和C组分别静注咪唑安定 0 0 4mg/kg或 0 0 6mg/kg ,6min后静注丙泊酚 ,速度均为1 5mg/s。静注丙泊酚或咪唑安定后 6min内每分钟进行OAA/S评分 ,并记录BIS。结果　 (1 )OAA/S与BIS具有显著等级相关 (r =0 81 9,P <0 0 1 )。三次模型拟合曲线可表示OAA/S与BIS之间的关系 (r =0 6 83,P<0 0 1 )。 (2 )以OAA/S =0分为判断丙泊酚效应指标 ,A组丙泊酚的ED50 和ED95分别为 1 0 9mg/kg和 1 6 4mg/kg ;B组和C组分别使丙泊酚的ED50 下降 5 2 3%和 6 0 5 % ,ED95下降 4 7 6 %和5 1 8%。 (3)静注丙泊酚后 1～ 2min ,BIS下降到最低值。与A组相比 ,B和C组使BIS降至相应值的丙泊酚需要量明显减少 ,同时BIS维持低水平的时间显著延长。结论　预先静注咪唑安定 0 0 4mg/kg可显著减少丙泊酚用量 ,并延长其作用时间     

咪唑安定用作高血压病人术前用药的临床观察

择期手术的高血压病人虽经术前准备血压控制在正常范围,但常因术前紧张而致入手术室时血压增高,咪唑安定因其强效的消除焦虑作用而可能有益于高血压病人,为此我们将咪唑安定用作高血压病人的术前用药并进行了临床观察。资料与方法对象与分组　择期手术高血压病人40例,均在60岁上下,无长期服用镇静药史,术前均经内科治疗,血压控制稳定(表1),抗高血压药皆服至手术当日晨,随机等分为两组。于麻醉前30分钟分别肌肉注射咪唑安定007ｍｇ/ｋｇ(Ａ组)或苯巴比妥钠01(Ｂ组)。Ｂ组中术前用药后血压≥24/147ｋＰａ的病例,再静脉注射咪唑安定0025ｍｇ/ｋ…     

Oral midazolam premedication and postoperative behaviour in children

We examined the effect of oral midazolam premedication on postoperative behaviour. Seventy children (ASA Physical Status 1 and 2; aged 1–10 yrs) were assigned randomly in a prospective, blinded fashion to receive either midazolam 0.5 mg·kg⁻¹ (maximum 10 mg) or placebo. Behaviour assessments were made prior to medication, during induction of anaesthesia and 15 min following arrival to recovery room. The baseline behavioural evaluation scores were not significantly different. The children receiving midazolam cried significantly less during induction (P≤0.02). At one week follow-up, eight of 35 subjects receiving placebo had experienced adverse behaviour changes (nightmares, night terrors, food rejection, anxiety, negativism); 19 of 35 of the midazolam group experienced these changes (P≤0.02). At four week follow-up, most behaviour changes had resolved. Children given preoperative oral midazolam were less likely to cry and fight while being anaesthetized, and preoperative sedation was associated with increased incidence of adverse postoperative behaviour changes.     

Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication

BACKGROUND: Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low-dose combination of oral midazolam and ketamine. METHODS: We performed a prospective randomized double-blind study in 100 children who were randomly allocated into two groups. Group M received 0.5 mg.kg(-1) oral midazolam and group MK received 0.25 mg.kg(-1) oral midazolam with 2.5 mg.kg(-1) oral ketamine. The preoperative sedation score, ease of parental separation and ease of mask acceptance were evaluated on a 4-point scale. The time to recovery from anesthesia and to achieve satisfactory Aldrete score was also noted. RESULTS: Uniform and acceptable sedation scores were seen in both the groups (group M 95.9%; group MK 97.96%), without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents (73.46% in MK vs 41% in group M). The induction scores were comparable between the groups. The recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups. CONCLUSIONS: Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.     

Dexmedetomidine vs midazolam for premedication of pediatric patients undergoing anesthesia

Background: Dexmedetomidine, an α₂‐receptor agonist, provides sedation, analgesia, and anxiolytic effects, and these properties make it a potentially useful anesthetic premedication. In this study, we compared the effects of intranasal dexmedetomidine and midazolam on mask induction and preoperative sedation in pediatric patients. Methods: Ninety children classified as ASA physical status I, aged between 2 and 9, who were scheduled to undergo an elective adenotonsillectomy, were enrolled for a prospective, randomized, and double‐blind controlled trial. All of the children received intranasal medication approximately 45–60 min before the induction of anesthesia. Group M (n = 45) received 0.2 mg·kg^?1 of intranasal midazolam, and Group D (n = 45) received 1 μg·kg^?1 of intranasal dexmedetomidine. All of the patients were anesthetized with nitrous oxide, oxygen, and sevoflurane, administered via a face mask. The primary end point was satisfactory mask induction, and the secondary end points included satisfactory sedation upon separation from parents, hemodynamic change, postoperative analgesia, and agitation score at emergence. Results: Satisfactory mask induction was achieved by 82.2% of Group M and 60% of Group D (P = 0.01). There was no evidence of a difference between the groups in either sedation score (P = 0.36) or anxiety score (P = 0.56) upon separation from parents. The number of patients who required postoperative analgesia was higher in the midazolam group (P = 0.045). Conclusion: Intranasal dexmedetomidine and midazolam are equally effective in decreasing anxiety upon separation from parents; however, midazolam is superior in providing satisfactory conditions during mask induction.     

Oral high-dose midazolam premedication for infants and children undergoing cardiovascular surgery

BACKGROUND: The purpose of this study was to determine whether oral midazolam 1.5 mg x kg(-1) is a safe and effective alternative to standard-dose midazolam (0.5-1.0 mg x kg(-1)) premedication for infants and children with congenital heart disease. METHODS: A total of 193 infants and children (4 months to 2 years) undergoing cardiovascular surgery were studied. Each patient received 0.5, 1.0, or 1.5 mg x kg(-1) of oral midazolam. The level of sedation was assessed with a 5-point scale and vital signs were measured including blood pressure (BP), heart rate (HR) and oxyhaemoglobin saturation (SpO2) before and after the medication. RESULTS: Infants and children premedicated with oral midazolam 1.5 mg x kg(-1) were better sedated than those with standard-dose midazolam: 4% of infants and children given 1.5 mg x kg(-1) of midazolam became agitated compared with 14% given 1.0 mg x kg(-1) and 26% in those given 0.5 mg x kg(-1). Ninety percentage of infants and children given 1.5 mg x kg(-1) of midazolam achieved satisfactory sedation (calm, drowsy, or asleep) in 30 min, whereas 68% in those given 1.0 mg x kg(-1) and 35% in those given 0.5 mg x kg(-1). Midazolam 1.5 mg x kg(-1) did not cause any statistically significant decrease in BP, HR, or SpO2, although eight infants and children showed > or =20% drop in systolic BP and six infants and children showed >5% drop in SpO2. No 'spelling attacks', seizure-like activity, apnoea, nor laryngospasm were observed in any infants and children during and after the medication. CONCLUSIONS: Oral midazolam 1.5 mg x kg(-1) is excellent for preanaesthetic medication for infants and children undergoing cardiovascular surgery.     

Oral premedication with midazolam in paediatric anaesthesia. Effects on sedation and gastric contents

The aim of this study was to assess oral premedication with midazolam in paediatric anaesthesia. Sedation, quality of induction, recovery time, acceptance and effects on gastric contents were analysed. This prospective, double blind, at random and controlled study was performed in 107 children, aged between three and ten years. They were divided into: group 1 (control, n=29), group 2 (placebo) receiving 5 ml of water in the preoperative stage (n=40), and group 3 (midazolam) with 0.75 mg·kg^-1 midazolam by mouth (n=38). Two children refused to take medication. In children aged five years or more (n=48) of groups 2 and 3, acceptance of premedication was evaluated. The midazolam group showed a better level of sedation as compared with the placebo (P<0.05). The recovery time was similar for the two groups. There were no statistically significant differences in gastric pH or residual volume among the three groups. It is concluded that midazolam given by mouth is an efficient and safe drug for premedication in paediatric anaesthesia.     

A comparison of midazolam co-induction with propofol predosing for induction of anaesthesia

In a double-blind, placebo-controlled study of 90 ASA 1 and 2 patients scheduled for elective surgery we compared the effect of pre-administering midazolam 2 mg or propofol 30 mg on the dose of propofol subsequently required to induce anaesthesia. Using loss of response to verbal command and tolerance to placement of a facemask as end-points, the dose of propofol required to induce anaesthesia was significantly smaller in the patients given propofol (1.87 mg.kg-1) or midazolam (1.71 mg.kg-1) when compared to the control group (2.38 mg.kg-1). Although the decrease in blood pressure following induction was no difference between the two study groups and the decrease was felt not to be of clinical significance in this group of patients. As propofol is presented ' ... for use in a single patient only' and the technique of predosing with propofol allowed induction of all patients with less than 200 mg (a single ampoule), we question on a cost basis whether midazolam co-induction is necessary to reduce propofol induction doses.     

QT interval of the ECG, heart rate and arterial pressure using propofol, methohexital or midazolam for induction of anaesthesia

The effects of propofol 2 mg/kg, methohexital 2 mg/kg or midazolam 0.3 mg/kg were studied on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during induction of anaesthesia in 87 ASA class I-(II)-patients. The patients were randomly allocated to one of the three anaesthetic groups. The incidence of the patients with a prolonged QTc interval (= more than 440 ms) ranged from 29 to 41% between the groups. In each group these patients were treated separately. After all anaesthetics, the QTc interval was significantly prolonged in the patients with a normal control QTc interval, whereas in the patients with a prolonged control QTc interval, it tended to be shortened both after propofol and methohexital and it was significantly shortened after midazolam. After injection of suxamethonium, no significant QTc interval changes occurred in the patients with a normal control QTc interval in either the propofol or the methohexital groups, whereas in the patients with a prolonged control QTc interval treated with propofol the QTc interval decreased significantly 60 s after suxamethonium when compared with the corresponding preceding values. The mean values in the propofol group in the patients with a normal control QTc interval were always below the upper limit of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of postoperative sedation with propofol and midazolam on pancreatic function assessed by pancreatitis-associated protein

This prospective randomised controlled study evaluated the effects of postoperative sedation with propofol and midazolam on pancreatic function. We studied 42 intensive care unit patients undergoing elective major surgery who were expected to be sedated postoperatively. Patients were randomly assigned to a propofol group (n = 21) or a midazolam group (n = 21). To assess pancreatic function, the following parameters were measured: pancreatitis-associated protein, amylase, lipase, cholesterol and triglyceride prior to start of sedation on the intensive care unit, 4 h after the sedation was started and at the first postoperative day. Patients in the propofol group received on average (SD) 1292 (430) mg propofol and were sedated for 9.03 (4.26) h. The midazolam group received 92 (36) mg midazolam and were sedated for 8.81 (4.68) h. Plasma cholesterol concentrations did not differ significantly between groups. Triglyceride plasma levels 4 h after the start of infusion were significantly higher in the propofol group (140 (54) mg.dl(-1)) than the midazolam-treated patients (81 (29) mg.dl(-1)), but were within normal limits. There were no significant differences between the two groups regarding amylase, lipase and pancreatitis-associated protein plasma concentrations at any time. No markers of pancreatic dysfunction were outside the normal range. We conclude that postoperative sedation with propofol induced a significant increase of serum triglyceride levels but that pancreatic function is unchanged with standard doses of propofol.     

Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication

BACKGROUND: Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. METHODS: Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg(-1) together with either morphine 0.15 mg kg(-1) or midazolam 0.30 mg kg(-1) approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. RESULTS: There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. CONCLUSION: In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia.     

A comparison between midazolam co-induction and propofol predosing for the induction of anaesthesia in the elderly

In a prospective, double-blind, randomised, placebo-controlled trial, we have compared the effects of midazolam co-induction with propofol predosing on the induction dose requirements of propofol in elderly patients. We enrolled 60 patients aged > 70 years, attending for urological surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg(-1), propofol 0.25 mg.kg(-1), or normal saline 2 ml (placebo) 2 min prior to induction of anaesthesia using propofol 1% infusion at 300 ml.h(-1). The propofol dose requirements for induction were recorded for two end-points (loss of verbal contact and insertion of an oropharyngeal airway). Cardiovascular parameters were recorded at 1-min intervals for each patient until induction was complete. The midazolam group showed a significant reduction in propofol dose requirements for induction (p = 0.05) compared to the placebo group. The propofol group did not show a significant dose reduction compared to placebo. There were no demonstrable differences in terms of improved cardiovascular stability between groups. We conclude that propofol predosing does not significantly reduce the induction dose of propofol required in the elderly, and there were no cardiovascular benefits to either midazolam co-induction or propofol predosing in the elderly.