We have compared sedation for fibreoptic bronchoscopy provided by incremental doses of midazolam with that provided by a computer-controlled infusion of propofol. These two methods were compared in terms of operator and patient acceptability, anxiolysis, effects on systolic arterial pressure and oxygen saturation. Tests were made also of memory and motor reactions, before and 60 min after the end of the procedure. Acceptability to operators and patients was high in both groups. There were no significant differences between the groups in systemic arterial pressure or anxiolysis. Oxygen saturation decreased in both groups (propofol group median 83% (range 69-95%); midazolam group median 86% (range 77-95%)) (ns). The median recovery time was 5 min (range 5-10 min) in the propofol group and 10 min (range 5-40 min) in the midazolam group (P < 0.01). Memory and motor reaction times 60 min after the end of the procedure did not differ from baseline in the propofol group, but were significantly impaired in the midazolam group.
We have studied patients presenting for coronary artery bypass surgery on two nights before surgery. Oxygen saturation during a night when the patient received no night sedation was compared with the night before surgery, when lorazepam 3-4 mg was given. There was no difference between the two nights when the total time at oxygen saturations less than 90% were compared, but the minimum oxygen saturation value when the patient received lorazepam was significantly smaller. No patient had significant sleep apnoea.
SummaryForty-eight patients were randomised to receive sedation for outpatient dental surgery with midazolam. Sedation was given using the Verrill technique (24 patients) and the Glasgow Dental Hospital technique (24 patients). The diferences in recovery and patient acceptability were assessed. There was no statistical diference in mean recovery times between the two groups. Memory function was examined using the Warrington memory test. Fewer patients in the Verrill group recalled the injection of local anaesthetic but they demonstrated memory defects 4 hours after sedation for words and 3 hours for faces. The Glasgow Dental Hospital group demonstrated memory defects for words up to 2 hours following sedation, but not for faces at any time. Thirty-eight patients would have dental surgery again with similar sedation. The dental surgeon found conditions for surgery inadequate in two patients. In view of the shorter duration of amnesia we recommend the Glasgow Dental Hospital technique.
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