Midazolam for sedation before procedures.
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ABSTRACT:
SUBMITTER: Conway A
PROVIDER: S-EPMC6517181 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:An open randomised, comparative study was planned to evaluate efficacy and tolerability of intramuscular midazolam and oral diazepam for preoperative sedation of patients under anaesthesia. 113 patients [diazepam=57;midazolam=56] of ASA grade I-II; between 18-60 years of age of either sex participated. Greater anxiety relief (p < 0.0001) was observed in the midazolam group compared to the diazepam group. Midazolam produced better clinically acceptable sedation of short duration. Excellent anterograde amnesia was seen with midazolam with lack of recall of intraoperative events during surgery. Cardiovascular stability was seen with both the drugs. Global quality of premedication assessed by the anaesthesiologist was excellent or good with midazolam as compared to satisfactory or poor with diazepam.
| S-EPMC5532121 | biostudies-other
Project description:Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE.A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey.A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented.Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P < .05 and P < .001, respectively).Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.
| S-EPMC6152553 | biostudies-literature
Project description:ObjectiveTo better understand 'when' and 'where' wideband electrophysiological signals are altered by sedation.MethodsWe generated animation movies showing electrocorticography (ECoG) amplitudes at eight spectral frequency bands across 1.0-116 Hz, every 0.1s, on three-dimensional surface images of 10 children who underwent epilepsy surgery. We measured the onset, intensity, and variance of each band amplitude change at given nonepileptic regions separately from those at affected regions. We also determined the presence of differential ECoG changes depending on the brain anatomy.ResultsWithin 20s following injection of midazolam, beta (16-31.5 Hz) and sigma (12-15.5 Hz) activities began to be multifocally augmented with increased variance in amplitude at each site. Beta-sigma augmentation was most prominent within the association neocortex. Augmentation of low-delta activity (1.0-1.5 Hz) was relatively modest and confined to the somatosensory-motor region. Conversely, injection of midazolam induced attenuation of theta (4.0-7.5 Hz) and high-gamma (64-116 Hz) activities.ConclusionsOur observations support the notion that augmentation beta-sigma and delta activities reflects cortical deactivation or inactivation, whereas theta and high-gamma activities contribute to maintenance of consciousness. The effects of midazolam on the dynamics of cortical oscillations differed across regions.SignificanceSedation, at least partially, reflects a multi-local phenomenon at the cortical level rather than global brain alteration homogeneously driven by the common central control structure.
| S-EPMC4747792 | biostudies-literature
Project description:PurposeThe optimal sedative regime that provides the greatest comfort and the lowest risk for procedural sedation in young children remains to be determined. The aim of this randomized, blinded, controlled, parallel-design trial was to evaluate the efficacy of intranasal ketamine and midazolam as the main component of the behavioral guidance approach for preschoolers during dental treatment.Materials and methodsChildren under seven years of age, with caries and non-cooperative behavior, were randomized into three groups: (KMIN) intranasal ketamine and midazolam; (KMO) oral ketamine and midazolam; or (MO) oral midazolam. The dental sedation appointments were videotaped, and the videos were analyzed using the Ohio State University Behavioral Rating Scale (OSUBRS) to determine the success of the sedation in each group. Intra- and postoperative adverse events were recorded. Data analysis involved descriptive statistics and non-parametric tests (P < 0.05, IBM SPSS).ResultsParticipants were 84 children (28 per group; 43 boys), with a mean age of 3.1 years (SD 1.2). Children's baseline and the dental sedation session characteristics were balanced among groups. The success of the treatment as assessed by the dichotomous variable 'quiet behavior for at least 60% of the session length' was: KMIN 50.0% (n = 14; OR 2.10, 95% CI 0.71 to 6.30), KMO 46.4% (n = 13; OR 1.80, 95% CI 0.62 to 5.40), MO 32.1% (n = 9) (P = 0.360). Adverse events were minor, occurred in 37 of 84 children (44.0%), and did not differ among groups (P = 0.462).ConclusionAll three regimens provided moderate dental sedation with minor adverse events, with marked variability in the behavior of children during dental treatment. The potential benefit of the ketamine-midazolam combination should be further investigated in studies with larger samples.Trial registrationClinicalTrials.gov, identifier: NCT02447289. Registered on 11 May 2015, named "Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO)."
| S-EPMC6411109 | biostudies-literature
Project description:ObjectivesTo systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation.Materials and methodsWe searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (?18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications.ResultsWe identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar.ConclusionsDexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.
| S-EPMC5249234 | biostudies-literature
Project description:Interventional procedures can produce pain, anxiety, and physical and mental distress. Analgesia and sedation in the interventional radiology suite are given routinely during interventional procedures and allow a safe, comfortable, and technically successful procedure to be performed. Appropriate sedation decreases patient movement, patient anxiety, pain perception, and is crucial to successfully perform percutaneous interventions. A thorough understanding of the preoperative patient assessment, intraprocedural monitoring, pharmacologic characteristics of medications, postoperative care, and treatment of complications is required for the practicing interventionalist. Complications related to sedation and analgesia can occur secondary to preexisting medical conditions, incorrect drug administration, and/or inadequate patient monitoring.1,2.
| S-EPMC3324208 | biostudies-other
Project description:Objectives/Aims:There has been no dentistry-specific published data supporting the use of monitoring with capnography for dental sedation. Our aim was to determine if adding capnography to standard monitoring during conscious sedation with midazolam would decrease the incidence of hypoxaemia. Materials and Methods:A randomised controlled trial was conducted in which all patients (ASA I and II) received standard monitoring and capnography, but were randomised to whether staff could view the capnography (intervention) or were blinded to it (control). The primary outcome was the incidence of hypoxaemia (SpO2?94%). Results:We enrolled 190 patients, mean age 31 years (range, 14-62 years). There were 93 patients in the capnography group and 97 in the control group. The mean cumulative dose of midazolam titrated was 6.94?mg (s.d., 2.31; range, 3-20?mg). Six (3%) patients, three in each group, required temporary supplemental oxygen. There was no statistically significant difference between the capnography and control groups for the incidence of hypoxaemia: 34.4 vs 39.2% (P=0.4962, OR=0.81, 95% CI: 0.45-1.47). Conclusions:We were unable to confirm an additive role for capnography to prevent hypoxaemia during conscious sedation with midazolam for patients not routinely administered supplemental oxygen.
| S-EPMC5842831 | biostudies-literature
Project description:Background/purposeOptimal sedation management for pediatric dental treatment demands special focus as it's tubeless and shares a same oral space. The study was to evaluate dexmedetomidine compared to midazolam for intranasal premedication in pediatric dental treatment under intravenous deep sedation.Materials and methodsA hundred children aged 3-7 years scheduled for elective dental treatment under intravenous deep sedation anesthesia were enrolled, of whom 50 children (Group D) were intranasally premedicated with 2.0 μg/kg dexmedetomidine and the remaining 50 children (Group M) received traditional 0.2 mg/kg midazolam. Acceptance rate of venipuncture was regarded as the primary endpoint.ResultsThe acceptance rate of venipuncture in Group D and Group M were 76% versus 52%, respectively (P = 0.021). More children in Group M complained about bitter/sour taste than Group D (62% vs. 8%, P < 0.001). Intraoperatively, children in Group M were found to have more choking cough than Group D (30% vs. 9%, P = 0.003), and patients in Group M required more suction (18 [36%] in Group M vs. 4 [8%] in Group D, P = 0.001). There were no significant differences between the groups in the incidences of temporal hypoxemia (SpO2 ≤ 90%), however, two children in Group M experienced hypoxemia over 10 s.ConclusionCompared to the 0.2 mg/kg midazolam, children premedicated with 2.0 μg/kg intranasal dexmedetomidine showed superior venipuncture acceptance, had less intraoperative choking cough and required fewer suction. It seems to be a good alternative to midazolam as premedication for deep sedation in pediatric dental treatment.
| S-EPMC10829544 | biostudies-literature
Project description:Altered connectivity within and between the resting-state networks (RSNs) brought about by anesthetics that induce altered consciousness remains incompletely understood. It is known that the dorsal attention network (DAN) and its anticorrelations with other RSNs have been implicated in consciousness. However, the role of DAN-related functional patterns in drug-induced sedative effects is less clear. In the current study, we investigated altered functional connectivity of the DAN during midazolam-induced light sedation. In a placebo-controlled and within-subjects experimental study, fourteen healthy volunteers received midazolam or saline with a 1-week interval. Resting-state fMRI data were acquired before and after intravenous drug administration. A multiple region of interest-driven analysis was employed to investigate connectivity within and between RSNs. It was found that functional connectivity was significantly decreased by midazolam injection in two regions located in the left inferior parietal lobule and the left middle temporal area within the DAN as compared with the saline condition. We also identified three clusters in anticorrelation between the DAN and other RSNs for the interaction effect, which included the left medial prefrontal cortex, the right superior temporal gyrus, and the right superior frontal gyrus. Connectivity between all regions and DAN was significantly decreased by midazolam injection. The sensorimotor network was minimally affected. Midazolam decreased functional connectivity of the dorsal attention network. These findings advance the understanding of the neural mechanism of sedation, and such functional patterns might have clinical implications in other medical conditions related to patients with cognitive impairment.
| S-EPMC8392174 | biostudies-literature
Project description:Background and aimStandardization of the sedation protocol during radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC) is needed. This randomized, single-blind, investigator-initiated trial compared clinical outcomes during and after RFA using propofol and midazolam, respectively, in patients with HCC.MethodsFew- and small-nodule HCC patients (≤3 nodules and ≤3 cm) were randomly assigned to either propofol or midazolam. Patient satisfaction was assessed using a 100-mm visual analog scale (VAS) (1 mm = not at all satisfied, 100 mm = completely satisfied). Sedation recovery rates 1, 2, 3, and 4 h after RFA were evaluated based on Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores; full recovery was defined as a MOAA/S score of 5.ResultsBetween July 2013 and September 2017, 143 patients with HCC were enrolled, and 135 patients were randomly assigned to the treatment group. Compared with midazolam, propofol exhibited similar median procedural satisfaction (propofol: 73.1 mm, midazolam: 76.9 mm, P = 0.574). Recovery rates 1 and 2 h after RFA were higher in the propofol group than in the midazolam group. Meanwhile, recovery rates observed 3 and 4 h after RFA were similar in the two groups. The safety profiles during and after RFA were almost identical in the two groups.ConclusionPatient satisfaction was almost identical in patients receiving propofol and midazolam sedation during RFA. Propofol sedation resulted in reduced recovery time compared with midazolam sedation in patients with HCC. The safety profiles of both propofol and midazolam sedation during and after RFA were acceptable.
| S-EPMC7857294 | biostudies-literature