Effect of Different Dosages of Intravenous Midazolam Premedication on Patients Undergoing Head and Neck Surgeries- A Double Blinded Randomized Controlled Study

Gupta, R. D.; Santha, Neeta; Upadya, Madhusudan; Manissery, Jesni Joseph

doi:10.7860/jcdr/2017/26414.10381

Cited by 7 publications

(9 citation statements)

References 14 publications

(1 reference statement)

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“…Oxygen levels (SpO 2 ) were not significantly associated with midazolam injection and stress. In a similar study, consistent with the results of this study, midazolam injection could reduce diastolic blood pressure but had no effect on other variables, including oxygen levels (16).…”

Section: Discussionsupporting

confidence: 89%

Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia

et al. 2023

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Background: The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate. Objectives: his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia. Methods: This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data. Results: Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation. Conclusions: The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.

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Section: Discussionsupporting

confidence: 89%

Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia

et al. 2023

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“…Remimazolam has been used in surgeries that require awakening the patient in the mid-surgery because it allows for rapid awakening (similar to propofol and antagonists). Since remimazolam is a benzodiazepine, it is expected to cause anterograde amnesia (similar to other benzodiazepines) [ 4 , 5 ] and to decrease the discomfort caused by intraoperative awakening; this property is expected to have a positive effect on preventing psychological trauma.…”

Section: Introductionmentioning

confidence: 99%

The effect of remimazolam on postoperative memory retention and delayed regeneration in breast surgery patients

et al. 2021

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Background: Remimazolam, a benzodiazepine ultra-short-acting sedative, has been used in general anesthesia since August 2020. It is used in awake surgeries that require awakening the patient in the middle of the surgery because of its rapid awakening effect as well as antagonistic interactions. If remimazolam has associated anterograde amnesia similar to benzodiazepines, it will have a positive effect on preventing psychological trauma. However, to our knowledge, the effect of remimazolam on anterograde amnesia has not been previously examined. Methods/design: The aim of this exploratory, open, propofol-controlled, single-center, randomized clinical trial is to examine the effect of remimazolam on postoperative memory retention and delayed regeneration. Seventy patients undergoing breast surgery will be included in the study. The patients will be randomly assigned to receive propofol or remimazolam as sedatives during surgery. The primary endpoint is the number of posters patients remember 24 hours after surgery (among 4 posters shown after awakening from anesthesia) as an assessment of anterograde amnesia. Secondary endpoints are retrograde amnesia, dose of analgesic given from the time the patient returns to the ward until 24 hours after surgery, immediate postoperative pain numerical rating scale scores, and pain numerical rating scale scores 24 hours after leaving the operating room. Recruitment will take place between October 2021 and March 2022 to achieve the target sample size. Discussion: To our knowledge, this is the first trial designed to examine the effects of remimazolam on postoperative memory retention and delayed regeneration in patients undergoing breast surgery. Trial registration: This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593).

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“…At 1 h after receiving premedications, ASSQ scores were significantly lower in study groups in comparison to baseline scores and at 1 h scores of P group patients, and this significant effect extended for 3-h PO. These findings indicated the necessity for therapeutic management of preoperative anxiety, despite the benefits Gupta et al (2017) found that higher dosage of midazolam improves the quality of anxiolysis and sedation with lesser rates of intraoperative recall and maintains hemodynamic stability, and Kunusoth et al (2019) also found that preoperative midazolam is effective in reducing the subjective stress with reliable anxiolysis while preserving protective reflexes. Moreover, the reported ΔΔASSQ between study groups was 25.9% between M2 and Z groups and 36.9% between M1 and M2 groups, thus indicating a more pronounced anxiolytic effect of melatonin 6-mg than 3-mg dose and than midazolam premedications.…”

Section: Discussionmentioning

confidence: 99%

Preoperative oral melatonin can reduce preoperative anxiety and postoperative analgesia in a dose-dependent manner

Lotfy

Ayaad

2021

Ain-Shams J Anesthesiol

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Background Preoperative anxiety has deleterious effects on patients’ outcome through its influence on intraoperative requirements of anesthetics and analgesics (Bayrak et al., J Coll Physicians Surg Pak 29:868–873, 2019), postoperative (PO) pain intensity, and analgesia requirement, and may even increase PO morbidity and mortality after certain types of surgery. Melatonin is a methoxyindole synthesized and secreted principally by the pineal gland at night under control of an endogenous rhythm of secretion generated by the suprachiasmatic nuclei. The current study hypothesized that preoperative melatonin could reduce patients’ anxiety and reduce intraoperative (IO) and postoperative (PO) analgesic in a dose-dependent manner. Results Preoperative consultation was, to some extent, effective in reducing patients’ anxiety and apprehension. At 1 h after receiving premedication, Anxiety Specific to Surgery Questionnaire (ASSQ) scores were significantly lower in study groups in comparison to baseline scores and at 1 h scores of P group patients (patients who received 3 ml of plain distilled water), and this significant effect extended for 3-h PO. The reported ∆∆ASSQ between study groups was 25.9% between M2 (melatonin) and Z (midazolam) groups and 36.9% between groups M1 (received melatonin in a dose of 3 mg) and M2 (received melatonin in a dose of 6 mg). Preoperative anxiolytic therapy allowed reduction of PO pain scores and analgesia consumption with prolongation of duration till 1st request of rescue analgesia, and these effects were more pronounced with melatonin 6 mg in comparison to placebo, melatonin 3mg, or midazolam. Conclusion Preoperative melatonin is an appropriate policy for reduction of preoperative anxiety and provided reduction of PO anxiety, pain scores, and consumption of analgesia thus promoting early recovery and short PO hospital stay. Dose dependency was evident, and preoperative melatonin 6-mg dose provided satisfactory effect.

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Effect of Different Dosages of Intravenous Midazolam Premedication on Patients Undergoing Head and Neck Surgeries- A Double Blinded Randomized Controlled Study

Abstract: Introduction: Benzodiazepines primarily acts on the central nervous system. Most patients are extremely anxious in the pre-operative period. Excessive anxiety adversely influences anaesthetic induction and often leads to functional impairment and poor recovery after surgery.

Cited by 7 publications

References 14 publications

Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia

Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia

The effect of remimazolam on postoperative memory retention and delayed regeneration in breast surgery patients

Preoperative oral melatonin can reduce preoperative anxiety and postoperative analgesia in a dose-dependent manner

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