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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: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.

Project description:BACKGROUND:The use of neostigmine after neuromuscular blockade (NMB) has been associated with postoperative respiratory complications. In previous studies, we found lower diaphragmatic activity after neostigmine reversal of NMB, compared to sugammadex. It is still unclear whether the adequate use of neostigmine guarantees normal respiratory muscle function after NMB. In this study, we wanted to assess the effect of commonly used degrees of NMB and their possible reversal strategies on respiratory muscle activity after the return of normal neuromuscular transmission. METHODS:This is a randomized, controlled, parallel-group, single-centre, double-blind study in patients scheduled for intracranial surgery at a tertiary academic hospital in Belgium. All participants received target controlled propofol/remifentanil anesthesia and were randomized into one of five groups, receiving either a shallow NMB with no reversal (shallow/saline), a shallow NMB with sugammadex reversal (shallow/sugammadex), a moderate NMB with neostigmine reversal (moderate/neostigmine), a moderate NMB with sugammadex reversal (moderate/sugammadex), or a deep NMB with sugammadex reversal (deep/sugammadex). Primary and secondary outcome parameters were diaphragm and intercostal electromyographic (EMG) activity at the moment of resumed spontaneous breathing activity, defined as a maximal interval of 10?min after the first spontaneous breath. RESULTS:For the five groups, a total of 55 patients could be included in the final analysis. Median time of spontaneous breathing analyzed was 5?min (IQR 3-9.5?min). Both the moderate/sugammadex and the moderate/neostigmine groups had lower levels of diaphragm EMG compared to the shallow/sugammadex group. The moderate/neostigmine group had lower levels of intercostal EMG activity compared to the shallow/saline group. CONCLUSIONS:In this study, the depth of neuromuscular blockade and type of reversal strategy impacts respiratory muscle activity at the moment of resumed spontaneous breathing and recovery of neuromuscular blockade. Both groups that received moderate NMB had lower levels of diaphragm EMG, compared to the shallow NMB group with sugammadex reversal. Compared to the shallow NMB group with no reversal, the moderate NMB with neostigmine reversal group had lower intercostal EMG activity. TRIAL REGISTRATION:Clinicaltrials.gov NCT01962298 on October 9, 2013 and EudraCT 2013-001926-25 on October 10, 2013.

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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.

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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