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Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery.

ABSTRACT: Preoperative anxiety is known to be related with the postoperative outcomes, although it remains unclear whether pharmacologic anxiolysis preoperatively leads to better postanesthesia recovery. Hence, the purpose of this study was to assess whether midazolam premedication would result in improved Quality of Recovery-40 survey scores, as a postoperative recovery parameter, in female patients undergoing mastectomy.This randomized double-blind study was performed at Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. Eighty-two females undergoing breast cancer surgery with propofol-remifentanil anesthesia were enrolled and randomized to receive midazolam 0.02?mg?kg (group M) or saline (group C). Anesthesia was conducted with total intravenous anesthesia using propofol and remifentanil. On postoperative day 1, the Quality of Recovery-40 survey scores were surveyed.The global Quality of Recovery-40 survey scores on postoperative day 1 did not significantly differ between groups M and C (183 vs 181, P?=?0.568). However, the induction time was significantly shorter in group M (3.2 vs 4.5?min, P?

SUBMITTER: Kim MH

PROVIDER: S-EPMC5319519 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery.

Kim Myoung Hwa MH Kim Min Soo MS Lee Jae Hoon JH Seo Jae Hi JH Lee Jeong-Rim JR

Medicine 20170201 7

<h4>Background</h4>Preoperative anxiety is known to be related with the postoperative outcomes, although it remains unclear whether pharmacologic anxiolysis preoperatively leads to better postanesthesia recovery. Hence, the purpose of this study was to assess whether midazolam premedication would result in improved Quality of Recovery-40 survey scores, as a postoperative recovery parameter, in female patients undergoing mastectomy.<h4>Methods</h4>This randomized double-blind study was performed ...[more]

PMID: 28207530

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Project description:BackgroundChildren under 6 years who need magnetic resonance imaging usually require sedation to obtain best quality images, but the optimal sedation protocol remains to be determined. In 2018, we showed a 22% interruption in image acquisition during magnetic resonance imaging when performing a propofol-based sedation using a bolus approach. As non-pharmacological premedication is often insufficient to reduce the anxiety of children related to parental separation, pharmacological premedication may be useful to facilitate the induction of anesthesia. In our institution, effective premedication is obtained oral intake of midazolam, though its administration relies on patients' compliance and could also lead to paradoxical reaction. Dexmedetomidine has a safe profile in the pediatric population and can therefore represent an interesting alternative. The primary objective of this trial is to demonstrate the superiority of intranasal dexmedetomidine compared to oral midazolam as premedication in reducing the occurrence of any event requiring temporary or definitive interruption of the examination to allow anesthesiologist intervention in children undergoing magnetic resonance imaging under propofol sedation.MethodsIn this single-center, prospective, randomized, double-blind, double-dummy, active comparator-controlled, superiority trial, we planned to include 250 patients, aged 6 months to 6 years, undergoing a scheduled magnetic resonance imaging requiring the presence of an anesthesiologist. After informed consent, the patients will be randomized to receive either oral midazolam or intranasal dexmedetomidine as premedication. The data will be analyzed in intention to treat, using Kolmogorov-Smirnov Z, chi-square, Wilcoxon, and Mann-Whitney U tests. A P-value < 0.05 will be considered statistically significant.DiscussionThe MIDEX MRI study will assess the efficacy of intranasal dexmedetomidine compared to oral midazolam to improve the quality of a propofol-based sedation prior to magnetic resonance imaging, without negative repercussion on the postoperative period.Trial registrationClinicalTrial.gov NCT05192629 . Registered on 14 January 2022. Protocol version 2.1.

Project description:BackgroundPostoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-acting benzodiazepine used frequently as premedication, increased the incidence of postoperative delirium.MethodsAnalyses of existing data were conducted using a database created from 3 prospective studies in patients aged 65 years or older who underwent elective major noncardiac surgery. Postoperative delirium occurring on the first postoperative day was measured using the confusion assessment method. We assessed the association between the use or nonuse of premedication with midazolam and postoperative delirium using a χ2 test, using propensity scores to match up with 3 midazolam patients for each control patient who did not receive midazolam.ResultsA total of 1266 patients were included in this study. Intravenous midazolam was administered as premedication in 909 patients (72%), and 357 patients did not receive midazolam. Those who did and did not receive midazolam significantly differed in age, Charlson comorbidity scores, preoperative cognitive status, preoperative use of benzodiazepines, type of surgery, and year of surgery. Propensity score matching for these variables and American Society of Anesthesiology physical status scores resulted in propensity score-matched samples with 1-3 patients who used midazolam (N = 749) for each patient who did not receive midazolam (N = 357). After propensity score matching, all standardized differences in preoperative patient characteristics ranged from -0.07 to 0.06, indicating good balance on baseline variables between the 2 exposure groups. No association was found between premedication with midazolam and incident delirium on the morning of the first postoperative day in the matched dataset, with odds ratio (95% confidence interval) of 0.91 (0.65-1.29), P = .67.ConclusionsPremedication using midazolam was not associated with higher incidence of delirium on the first postoperative day in older patients undergoing major noncardiac surgery.

Project description:ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.ResultsAfter matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48-66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2-4). Obese and non-obese patients had similar rates of grade III-IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I-II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35-72.5) vs 50 mg (IQR 25-622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10-96.2) vs 29.37 mg/day (IQR 7.5-70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).ConclusionsNeither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

Dataset Information

Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery.

Publications

Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery.

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