Midazolam coinduction does not delay discharge after very brief propofol anaesthesia

Elwood, Tom; Huchcroft, Shirley A.; MacAdams, Charles

doi:10.1007/bf03028262

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…This was a dose‐dependent phenomenon, since the total induction dose of propofol was reduced by as much as 40% in the midazolam group. These findings are consistent with several previous studies [6, 7, 10], which showed that the combination of propofol with midazolam, with or without alfentanil, significantly reduced the induction dose of propofol, thus minimising the hypotension following the induction of anaesthesia. When midazolam was replaced with propofol in the PP group there was still a significant 23% reduction in the total induction dose of propofol.…”

Section: Discussionsupporting

confidence: 93%

“…The high‐dose midazolam caused measurable but statistically insignificant delay in discharge time (mean 15 min) when compared with low‐dose midazolam and control groups. The Canadian group [10] showed that addition of either midazolam 0.03 or 0.06 mg.kg −1 to propofol induction did not affect the discharge times following minor gynaecological procedures. Godsiff et al .…”

Section: Discussionmentioning

confidence: 99%

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Propofol auto‐co‐induction as an alternative to midazolam co‐induction for ambulatory surgery

Djaiani

Ribes-Pastor

1999

Anaesthesia

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SummaryWe propose the use of an intravenous propofol/propofol auto-co-induction technique as an alternative to propofol/midazolam for induction of anaesthesia. We have studied 54 unpremedicated ASA 1 or 2 patients undergoing day-stay anaesthesia for minor orthopaedic surgery. All received 10 mg.kg À1 of alfentanil before induction, followed by either midazolam 0.05 mg.kg À1 , propofol 0.4 mg.kg À1 or saline, and 2 min later, a propofol infusion at a rate of 50 mg.kg À1 .h À1 until loss of eyelash reflex. We compared pre-and postinduction haemodynamic changes, complications at insertion of a laryngeal mask airway and recovery from anaesthesia in the three groups. Both co-induction techniques showed less postinduction hypotension and significant reduction of the total induction dose of propofol when compared to the control group.In the propofol/propofol group there was a decreased incidence of apnoea during induction of anaesthesia. These patients were discharged from hospital 2 h after the end of anaesthesia whereas patients in the midazolam/propofol group were discharged after 2 Anaesthetic regimens used for ambulatory surgery are primarily aimed at improving recovery from anaesthesia and shortening discharge times from hospital. This improves the efficiency of day surgery units and helps to meet the increasing demand for ambulatory surgery. It results in a faster throughput of patients with obvious economic benefits. The most popular 'day stay' anaesthetic agent is propofol. It has a good safety record, but when used as the sole induction agent it causes a significant decrease in arterial blood pressure [1-3] and cardiac output [4, 5]. In order to balance the ratio of desired versus adverse effects and decrease the costs, the concept of co-induction has attractions for outpatient anaesthesia. The synergism that occurs between propofol and midazolam, given with or without alfentanil, reduces the total dose of propofol required [6][7][8], thus modifying induction of anaesthesia and lessening the undesirable cardiovascular effects of monotherapy. However, the addition of midazolam delays psychomotor recovery of patients in the postoperative period [9] and may prolong patients' discharge from the hospital. The aim of this study was to compare postinduction haemodynamic effects and recovery profile using three different co-induction techniques. Methods

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Propofol auto‐co‐induction as an alternative to midazolam co‐induction for ambulatory surgery

Djaiani

Ribes-Pastor

1999

Anaesthesia

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“…We were unable to demonstrate any difference in adverse events such as coughing, laryngospasm or involuntary movements between groups. There is conflicting data in the literature with respect to time to discharge, which reflects differences in study design [15, 16].…”

Section: Discussionmentioning

confidence: 99%

A comparison between midazolam co‐induction and propofol predosing for the induction of anaesthesia in the elderly

Jones¹,

Elliott

Knight³

2002

Anaesthesia

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SummaryIn a prospective, double-blind, randomised, placebo-controlled trial, we have compared the effects of midazolam co-induction with propofol predosing on the induction dose requirements of propofol in elderly patients. We enrolled 60 patients aged > 70 years, attending for urological surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg )1 , propofol 0.25 mg.kg )1 , or normal saline 2 ml (placebo) 2 min prior to induction of anaesthesia using propofol 1% infusion at 300 ml.h )1 . The propofol dose requirements for induction were recorded for two end-points (loss of verbal contact and insertion of an oropharyngeal airway). Cardiovascular parameters were recorded at 1-min intervals for each patient until induction was complete. The midazolam group showed a significant reduction in propofol dose requirements for induction (p ¼ 0.05) compared to the placebo group. The propofol group did not show a significant dose reduction compared to placebo. There were no demonstrable differences in terms of improved cardiovascular stability between groups. We conclude that propofol predosing does not significantly reduce the induction dose of propofol required in the elderly, and there were no cardiovascular benefits to either midazolam co-induction or propofol predosing in the elderly.

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“…It would appear that this is not a valid concern. A study by Elwood has shown that the use of midazolam, in the doses used in our study, does not delay discharge after anaesthesia [25].…”

Section: Discussionmentioning

confidence: 76%

Midazolam reduces the dose of propofol required for induction of anaesthesia and laryngeal mask airway insertion

2001

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Midazolam coinduction does not delay discharge after very brief propofol anaesthesia

Cited by 20 publications

References 18 publications

Propofol auto‐co‐induction as an alternative to midazolam co‐induction for ambulatory surgery

Propofol auto‐co‐induction as an alternative to midazolam co‐induction for ambulatory surgery

A comparison between midazolam co‐induction and propofol predosing for the induction of anaesthesia in the elderly

Midazolam reduces the dose of propofol required for induction of anaesthesia and laryngeal mask airway insertion

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