Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study

Steiner, C.; Steurer, Marc P.; Mueller, Deborah; Zueger, Max; Dullenkopf, Alexander

doi:10.1186/s12871-016-0262-6

Cited by 16 publications

(13 citation statements)

References 11 publications

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“…Nevertheless, the not insignificant percentage of patients in which the midazolam plasma levels increased during the short procedure, would support the above-mentioned notion. The proportion of patients in our cohort with a higher midazolam plasma level at the end of the operation is similar to the one described by Steiner, et al [11] . They investigated 22 adult patientsthat underwent short gynecological procedures (approximately 20 minutes), and found in 5 patients (27%), plasma levels to be higher at the end of the operation than during the anesthesia induction.…”

Section: Discussionsupporting

confidence: 88%

Midazolam Plasma Concentrations in Children after Anesthetic Premedication for Short Routine Cases - An Observational Study

Dullenkopf¹,

Späti²,

Forster³

et al. 2017

JAS

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Introduction: Midazolam is commonly used in pediatric patients as a sedative and anxiolytic before the induction of anesthesia. Little is known about clinically resulting plasma levels in the setting of short procedures. Aim of this study was to compare plasma levels of Midazolam at the end of intervention with the corresponding levels at the time point of anesthesia induction for short procedures. The hypothesis was that a certain percentage of patients have higher levels at the end of the procedure. Method: Twenty pediatric patients between the age of 2 and 8 years, scheduled for short (< 30 minutes) surgical procedures requiring general anesthesia were prospectively enrolled. They all received 0.5 mg/kg Midazolam rectally (maximum dose 10 mg) 30 minutes before transport to the operating room. After induction of the general anesthetic, a first blood sample was obtained, and plasma midazolam levels were determined. A second sample was collected at the end of the procedure. Results: Three patients had to be excluded from the study, because no midazolam plasma levels were detectable. Midazolam plasma levels were 0.38 ± 0.19 μmol/l in the first blood samples, and 0.2 ± 0.12 μ mol/l at the second time point. In three patients (17.6 %), the midazolam plasma level was higher at the end of the procedure than at the induction of anesthesia. Conclusion: A considerable percentage of patients displayed a higher plasma level of Midazolam at the end of the procedure (compared to the moment of anesthesia induction). This may have implications for the post-operative period.

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Section: Discussionsupporting

confidence: 88%

Midazolam Plasma Concentrations in Children after Anesthetic Premedication for Short Routine Cases - An Observational Study

Dullenkopf¹,

Späti²,

Forster³

et al. 2017

JAS

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“…By only including people who had a postoperative stay of at least three days, all perioperative medication lost its pharmacological effect during the hospital stay, and all patients had to deal with their psychological symptoms under the same conditions. 29 We did not find any symptoms of paradoxical effects or a rebound phenomenon due to midazolam.…”

Section: Discussionmentioning

confidence: 52%

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Beek¹,

Kroon²,

Rijs³

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. Methods We conducted a single-centre randomized placebo-controlled, double-blinded clinical trial from July 2014 to September 2015. We included 192 patients aged [ 18 yr scheduled for elective laparotomy with a planned postoperative stay of C three days. Participants were randomized into two groups to receive either midazolam 3 mg or sodium chloride 0.9% intravenously as premedication prior to surgery. Patients were followed up for up to one week after surgery. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day (POD) 3. The secondary outcomes included the QoR-40 score on POD 7, and the State-Trait Anxiety Inventory, State-Trait Anger Scale, Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale scores. Results The mean (standard deviation) postoperative QoR-40 scores on POD 3 were not significantly different in the midazolam group compared with controls [166.4 (17.0) vs 163.9 (19.8), respectively; mean difference, 2.3; 95% confidence interval,-2.9 to 8.4; P = 0.35]. There were no between-group differences in any of the secondary outcomes. Conclusions Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients. Trial registration www.clinicaltrials.gov (NCT01993459); registered

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“…Midazolam with rapid onset of action and potent amnestic properties has been the most commonly used drug among benzodiazepines 5 . Nevertheless, the rather long half‐life of approximately 1.8 to 6.4 h (the shortest for any of the benzodiazepines) possibly results in a comparatively long sedative effect of midazolam 14,15 . In addition, midazolam has an active metabolite which may lead to a longer and less predictable recovery from sedation 16 .…”

Section: Introductionmentioning

confidence: 99%

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

Chen

Yuan

Zhang

et al. 2020

J of Gastro and Hepatol

156

158

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Background and Aim Remimazolam tosilate (RT) is a new short‐acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. Methods This positive‐controlled, non‐inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. Results The success rate of sedation in the RT group was non‐inferior to that in the propofol group (97.34% vs 100.00%; difference in rate −2.66%, 95% CI −4.96 to −0.36, meeting criteria for non‐inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment‐related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). Conclusion This trial established non‐inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.

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Midazolam plasma concentration after anesthesia premedication in clinical routine - an observational study

Cited by 16 publications

References 11 publications

Midazolam Plasma Concentrations in Children after Anesthetic Premedication for Short Routine Cases - An Observational Study

Midazolam Plasma Concentrations in Children after Anesthetic Premedication for Short Routine Cases - An Observational Study

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non‐inferiority, phase III trial

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