Induction of anaesthesia with midazolam and a target‐controlled propofol infusion

Tzabar, Y.; Brydon, C.; Gillies, G. W. A.

doi:10.1111/j.1365-2044.1996.tb12558.x

Cited by 22 publications

(15 citation statements)

References 7 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…DeLucia & White [7] studied a combination of fentanyl, midazolam and propofol and recorded a significantly greater decrease in mean arterial pressure during induction when midazolam 2 mg was used. However, other studies have found no statistically significant differences in arterial pressure between groups receiving midazolam and propofol or propofol alone [2,4,11]. It therefore seems that, although the addition of midazolam reduces the propofol dose requirements significantly, it does not necessarily lead to better maintenance of arterial blood pressure during induction and may cause a transiently lower decrease in systolic and mean pressures.…”

Section: Discussionmentioning

confidence: 92%

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Cressey¹,

Claydon²,

Bhaskaran

et al. 2001

Anaesthesia

View full text Add to dashboard Cite

SummaryIn a double-blind, randomised trial, we compared the effects of pretreatment with midazolam at two different doses (0.025 and 0.05 mg.kg 21 ), with placebo, on the induction dose requirements of propofol in two different age groups. We enrolled 120 patients: 60 younger patients (aged 18± 35 years) and 60 older patients (aged over 60 years). All patients received 0.75 m g.kg 21 of fentanyl, plus a blinded pretreatment with either saline or one of two doses of midazolam. Induction continued with a fixed rate infusion of propofol. Propofol dose requirement was recorded, as were cardiovascular parameters and the occurrence of significant apnoea (. 60 s). Midazolam pretreatment was associated with a significant reduction in propofol dose requirement in both younger and older patients. The reduction in older patients was significantly greater than the equivalent response in younger groups. There was no demonstrable benefit in terms of improved cardiovascular stability or reduction in the incidence of apnoea. Caution is advised in the use of midazolam as an agent for co-induction with propofol in the elderly.

show abstract

Section: Discussionmentioning

confidence: 92%

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Cressey¹,

Claydon²,

Bhaskaran

et al. 2001

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…[14][15][16][17] Therefore, benzodiazepine reduces propofol requirements probably due to its synergistic action on GABA A -receptor. 3,7,8 Although we maintained the same sedation level in all groups, fewer patients in Group-DZ recalled intraoperative events than in other groups. Benzodiazepines, including diazepam, produce anterograde amnesia, and this may contribute to this reduction of the memories of intraoperative events.…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, benzodiazepines and propofol act synergistically. 3,7,8 It is possible that preanesthetic diazepam reduces the propofol requirements and decreases the complications. Both drugs are useful for premedication, however, there are few reports to investigate the differences between them when used as premedicants for sedation with propofol.…”

Section: Discussionmentioning

confidence: 99%

Premedication modifies the quality of sedation with propofol during regional anesthesia

Nakagawa

Mammoto

Sakai

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To determine the effects of diazepam or clonidine on the quality of sedation with propofol during regional anesthesia.Methods: In a prospective randomised, controlled, double-blinded study, 60 patients undergoing elective gynecological surgery were studied. They were given premedication with 0.15-mg clonidine (Group-CL, n=20), 5-mg diazepam (Group-DZ, n=20), or placebo (Group-P, n=20) po. After spinal anesthesia was established, sedation was provided with propofol and controlled using a five-point sedation score at 3, "eyes closed but rousable to command", and 4, "eyes closed but rousable to mild physical stimulation". During sedation, blinded anesthesiologist recorded occurrence of complications. At two hours after end of sedation, patients were asked if they had intraoperative dream and memory.Results: The loading dose, steady-state infusion rate, and overall mean infusion rate in Group-CL were 0.80 mg·kg -1 , 2.35 mg·kg -1 ·hr -1 and 2.89 mg·kg -1 ·hr -1 , compared with 0.97 mg·kg -1 , 3.13 mg·kg -1 ·hr -1 and 3.59 mg·kg -1 ·hr -1 in Group-DZ, and 1.38 mg·kg -1 , 4.10 mg·kg -1 ·hr -1 and 4.36 mg·kg -1 ·hr -1 in Group-P, respectively. Indices of both Group-CL (P <0.001) and Group-DZ (P <0.05) were smaller than those of Group-P. Moreover, clonidine reduced the incidence of uncontrolled movement (P <0.01), while diazepam reduced the incidence of intraoperative memory and increased the incidence of dream (P <0.05). Premedication did not affect the incidence of other complications.Conclusion: Both premedicants reduced propofol requirements and exerted beneficial effects on the incidence of some complications during sedation with propofol as an adjunct to regional anesthesia.Objectif : Déterminer les effets du diazépam ou de la clonidine sur la qualité de la sédation avec du propofol pendant l'anesthésie régionale.Méthode : L'étude prospective, randomisée, contrôlée et à double insu a été menée auprès de 60 patientes qui devaient subir une intervention gynécologique planifiée. Une prémédication avec 0,15 mg de clonidine (Groupe CL, n = 20), 5 mg de diazépam (Groupe DZ, n = 20), ou un placebo (Groupe P, n = 20) po a d'abord été administrée. Puis, une rachianesthésie a été réalisée et une sédation fournie avec du propofol et contrôlée en utilisant un score de sédation en cinq points où le point 3 dit "yeux fermés mais se réveille sur commande" et le point 4, "yeux fermés, mais se réveille avec une stimulation physique légère". Pendant la sédation, un anesthési-ologiste impartial a enregistré l'occurrence de complications. Deux heures après la fin de la sédation, on a demandé aux patientes si elles ont eu des rêves ou se souviennent d'événements peropératoires.Résultats : La dose de charge, la vitesse de perfusion à l'état d'équilibre et la vitesse de perfusion globale moyenne ont été, dans le Groupe CL de 0,80 mg·kg -1 , de 2,35 mg·kg -1 ·h -1 et de 2,89 mg·kg -1 ·h -1 , comparées à 0,97 mg·kg -1 , 3,13 mg·kg -1 ·h -1 et 3,59 mg·kg -1 ·h -1 dans le Groupe DZ, et à 1,38 mg·kg -1 , 4,10 mg·kg -1 ·h -1 et 4,36 ...

show abstract

“…Oxorn et al (1997) did not observe any significant effect of midazolam on the propofol requirement whereas others have demonstrated an approximate 50% reduction in propofol dose for induction of anaesthesia if midazolam is given up to 10 minutes prior to propofol administration (Short & Chui 1991;Ong et al 2000). Premedication with midazolam also increased the number of human patients achieving successful induction of general anaesthesia with a fixed low target of PTCI without major cardiovascular effects (Tzabar et al 1996). In dogs, however, midazolam administered as an intramuscular (IM) premedication or intravenous (IV) co-induction agent, at doses of 0.1 and 0.2 mg kg À1 respectively, resulted in excitement and only a mild reduction in propofol requirement for induction of anaesthesia (Stegmann & Bester 2001;Covey-Crump & Murison 2008;Hopkins et al 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Premedication with midazolam also increased the number of human patients achieving successful induction of general anaesthesia with a fixed low target of PTCI without major cardiovascular effects (Tzabar et al. ). In dogs, however, midazolam administered as an intramuscular (IM) premedication or intravenous (IV) co‐induction agent, at doses of 0.1 and 0.2 mg kg −1 respectively, resulted in excitement and only a mild reduction in propofol requirement for induction of anaesthesia (Stegmann & Bester ; Covey‐Crump & Murison ; Hopkins et al.…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of midazolam or lidocaine co-induction with a propofol target-controlled infusion (TCI) in dogs

Minghella

Auckburally

Pawson

et al. 2016

Veterinary Anaesthesia and Analgesia

View full text Add to dashboard Cite

Objective To evaluate the propofol requirement, cardiovascular and respiratory variables using midazolam or lidocaine with a propofol target‐controlled infusion (PTCI) for induction of anaesthesia in healthy dogs. Study design Prospective, randomized, controlled blinded clinical trial. Animals Sixty client‐owned dogs [American Society of Anesthesiologists (ASA) I–II] undergoing surgical procedures. Methods Thirty minutes after premedication with acepromazine (0.03 mg kg−1) and morphine (0.2 mg kg−1), PTCI was started and maintained at a plasma target concentration of 1 μg mL−1. Three minutes later, dogs (n = 20 per group) received either 5 mL 0.9% sodium chloride (SG), 2 mg kg−1 of lidocaine (LG) or 0.2 mg kg−1 of midazolam (MG) intravenously (IV) as a co‐induction agent. Two minutes later, suitability for endotracheal intubation was assessed. If intubation was not possible, the propofol target was increased by 0.5 μg mL−1 every 60 seconds until it was successfully achieved. Heart rate (HR), respiratory rate (fR), and oscillometric systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure (DAP) were recorded immediately prior to commencing PTCI (B0), prior to intubation (BI), immediately after (T0), and at 3 (T3) and 5 (T5) minutes post‐intubation. End‐tidal partial pressures of carbon dioxide (PE′CO2) were recorded at T0, T3 and T5. The occurrence of excitement at any time point was noted. Results The median (range) propofol target concentration for endotracheal intubation was significantly lower in MG, 1.5 (1.0–4.0) μg mL−1 compared with LG, 2.5 (1.5–4.5) μg mL−1 or SG, 3.0 (2.0–5.0) μg mL−1. Heart rate, MAP, fR and PE′CO2 were similar in the three groups at all time points. No excitement was reported in any dog. Conclusions and clinical relevance Midazolam, but not lidocaine, provided a significant reduction in PTCI requirement for induction of anaesthesia thereby allowing successful intubation. However, cardiovascular and respiratory effects were not different between the groups.

show abstract

Induction of anaesthesia with midazolam and a target‐controlled propofol infusion

Abstract: Summary

Cited by 22 publications

References 7 publications

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Effect of midazolam pretreatment on induction dose requirements of propofol in combination with fentanyl in younger and older adults

Premedication modifies the quality of sedation with propofol during regional anesthesia

Clinical effects of midazolam or lidocaine co-induction with a propofol target-controlled infusion (TCI) in dogs

Contact Info

Product

Resources

About