Evaluation of midazolam as an intravenous induction agent

Gamble, J. A. S.; Kawar, P.; Dundee, John W.; Moore, J.; Briggs, L.P.

doi:10.1111/j.1365-2044.1981.tb08859.x

Cited by 105 publications

(30 citation statements)

References 11 publications

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“…This is consistent with published evidence for both drugs (Gale, 1976;Dundee et al, 1980;Gamble et al, 1981).It is relevant that many patients given midazolam (in combination with pethidine) had complete lack of recall of events of the first 2 h of the recovery period. Both midazolam and diazepam can produce pain and local reaction immediately after injection; the reported frequency is 1 -6% after diazepam in emulsion (Von Dardel, Mebius and Mossberg, 1976;Schou Oleson and Huttel, 1980;Jensen, Huttel and Schou Oleson, 1981) and 1.2-6% after midazolam (Gamble et al, 1981;Jensen, Huttel and Schou Oleson, 1981). In our study, only 2% in the diazepam and 1% in the midazolam group complained of pain, despite injection into small veins.…”

Section: Discussionsupporting

confidence: 80%

“…Since pethidine pretreatment increases the soporific action of both diazepam (Dundee et al, 1970) and midazolam (Gamble et al, 1981), our results are not directly comparable to other studies on either benzodiazepine used alone. In combination with pethidine, midazolam produced more profound sedation than diazepam in this study.…”

Section: Discussioncontrasting

confidence: 55%

“…The reported frequency of thrombophlebitis at 10-14 days after injection of Diazemuls is about 6% (Schou Oleson and Huttel, 1980;Jensen, Huttel and Schou Oleson, 1981) and about 8-10% after midazolam (Gamble et al, 1981;Jensen, Huttel and Schou Oleson, 1981). There seems to be an irreducible number, independent of the drug, since Mikkelsen, Hoel and Bryne (1980) reported thrombophlebitis in 6.7% of patients after injection of saline alone.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

Magni

Frost

Leung

et al. 1983

British Journal of Anaesthesia

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SUMMARYOne hundred and eighty-five patients were allocated at random to receive pethidine with diazepam (in an emulsion), or pethidine with miHuTnlam i. v. as sedation for upper gastrointestinal endpscopy. Sedation and conditions for examination were comparable and satisfactory in both groups. Midazolam produced more amnmia (P-<0.001), and scored higher in patients' opinion (P to <0.001); it was associated with a slightly greater frequency of venous sequelae, but the difference in thrombophlebitis was not statistically significant. Recovery of sensory -motor performance, as assessed by Trieger test, was still incomplete 2h after endoscopy with, both drug regimens.The intravenous administration of benzodiazepines is popular for endoscopic procedures. Diazepam is used widely, but has certain disadvantages, including variation in response (Dundee and Haslett, 1976), prolonged action with second peak effect at 6-8 h (Baird and Hailey, 1972; Kaplanetal:, 1973), pain on injection (Siebke, Ellertsen and Lind, 1976; Schou Oleson and Huttel, 1980), and a high frequency of thrombophlebitis (Hegarty andDundee, 1977, 1978). Local complications are less When it is used in an emulsion (Diazemiils, Kabi-Vitrum) (Von Dardcl, Mcbius and Mossberg, 1976), but the other disadvantages remain (Thorn-Alquist, 1977). Recent interest has focused on midazolam (Roche), a water-soluble benzodiazepine, which has shorter duration of action (Dundee et al., 1980;Smith, Eadie and O'Rourke Brophy, 1981) and causes less venous irritation (Jensen, Huttel and Schou Oleson, 1981).Midazolam and diazepam in emulsion (Diazemuls) (both in combination with pethidine) were compared as sedatives for upper gastrointestinal (GI) endoscopy and endoscopic retrograde cholangio-pancreatography (ERCP). The sedative and amnesic effect, ease of endoscopy, patient acceptability, speed of recovery and venous sequelae were assessed. PATIENTS AND METHODSOne hundred and eighty-five patients conforming to ASA Grade I and II participated in the study.Patients with a history of drug allergy, previous adverse response to anaesthetics or benzodiazepines, pregnant women, and patients with evidence of gastric or oesophageal obstruction were excluded. All patients gave informed consent, and the study was approved by the Clinical Investigations Panel of The Middlesex Hospital and Medical School. Before endoscopyHeart rate, arterial pressure and respiratory rate were recorded, and the patients completed a sensory-motor performance test (Trieger test) which involved joining a pattern of dots on a sheet of paper. The test was scored according to the number of dots missed, total millimetre deviation from target, and the time taken to complete the test. The return to baseline performance was directly related to recovery (Newman, Trieger and Miller, 1969).A disposable Teflon canriula (Venflon Viggo 20-gauge) was inserted into a vein of the back of the hand. The size of the vein was noted. Patients were withdrawn from the part of the study concerned with venous sequelae if haematom...

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

Magni

Frost

Leung

et al. 1983

British Journal of Anaesthesia

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“…It can be used in higher dosage for induction of anaesthesia, although it is less reliable than thiopentone (Gamble et al, 1981).…”

Section: Introductionmentioning

confidence: 99%

Prolonged midazolam elimination half‐life.

Dundee¹,

Collier²,

Carlisle³

et al. 1986

Brit J Clinical Pharma

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1 The pharmacokinetics of a fixed dose of midazolam (0.3 mg kg-1 i.v.) were studied in detail in 115 healthy patients or volunteers and nine were found with a prolonged elimination half-life. 2 A further 102 patients had an abbreviated pharmacokinetic study, of whom five showed a similar abnormality. 3 Defective hepatic metabolism of midazolam may be a factor in the aetiology of what appears to be a true phenomenon, occurring in 6% of over 200 fit subjects given a standard dose of the drug.

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“…These variations in response are typical of benzodiazepines'O and may be partly explained by high plasma protein binding. 8 The mean total dose of midazolam required to produce COmpdrdbk operating conditions in the same set of patients was half that of tiiazepam (0.17 mg/kg vs 0.32 mg/kg). This suggests that midazolam is about twice as potent as diazepam, which is consistent with the results of other studies.11.12 The mean dose of midazolam given in this study is larger than that recommended by the manufacturer for intravenous sedation (0.07 mg/kg).…”

Section: Discussionmentioning

confidence: 99%

A comparison of midazolam and diazepam for intravenous sedation in dentistry

Aun

Flynn

Richards³

et al. 1984

Anaesthesia

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Summary In a randomised cross‐over trial, midazolam, a new water soluble benzodiazepine was compared with the conventional diazepam preparation (Valium) in 34 patients aged 16—45 years who were undergoing outpatient conservation dentistry. Midazolam hydrochloride (0.17 mg/kg) was virtually free of venous complications and showed advantages over diazepam (0.32 mg/kg) in providing a faster onset of action, higher incidence of amnesia and more rapid recovery. Midazolam produced a higher incidence of respiratory side effects: hiccough (17.6% compared with 2.9%), brief apnoea following induction (11.8% compared with 5.8%), and airway obstruction during maintenance (8.8%, compared with 0%). These may be related to the greater potency of midazolam as suggested by the smaller total dose required. Cardiovascular changes and operating conditions were similar.

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Evaluation of midazolam as an intravenous induction agent

Abstract: Summary Midazolam, a new water-soluble benzodiazepine, was investigated as an intravenous anaesthetic agent in

Cited by 105 publications

References 11 publications

A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

Prolonged midazolam elimination half‐life.

A comparison of midazolam and diazepam for intravenous sedation in dentistry

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