Midazolam versus Fentanyl/Droperidol and Placebo as Intramuscular Premedicant

Wijhe, Marten van; Voogt-Frenkel, E. De; Stijnen, T.

doi:10.1111/j.1399-6576.1985.tb02225.x

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…Effects experienced placebo patients demonstrated a significant beneficial effect from the placebo premedication, although the effects were less than with active drugs. This is in agreement with the findings of other authors (15,16) who have reported a significant placebo effect on anxiety, pain and alertness. The physiological bases for these placebo effects are thought to result from changes in endogenous endorphine secretion in the central nervous system (1 7).…”

Section: Patients' Ideal Premedication Effectssupporting

confidence: 94%

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Premedication with midazolam in out‐patient general anaesthesia. A comparison with morphine‐scopolamine and placebo

Ræder¹,

Breivik²

1987

Acta Anaesthesiol Scand

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Strong premedication may prolong recovery and cause side-effects after short surgical procedures in general anaesthesia. To be operated without premedication may be unpleasant for the patient. Midazolam is a water-soluble benzodiazepine with rapid onset and short half-life. In a randomized study with 193 female patients, we compared the effects and side-effects of three different premedicants i.m.: midazolam, morphine-scopolamine (Mo-Scop) and placebo. Midazolam and Mo-Scop had an equal and significantly better effect than placebo on preoperative anxiety and alertness. Side-effects like nausea, dry mouth and prolonged recovery occurred significantly more often in the Mo-Scop than the midazolam or placebo groups. The midazolam-premedicated patients had significantly more amnesia compared with the other two groups. Only 3% of the patients would prefer no medication before anaesthesia, whereas 80% would prefer a combination of an anxiolytic and hypnotic premedication. Sixty-three percent of the patients would prefer a premedicant administered by injection. The results indicate that midazolam i.m. is an effective premedicant, with few side-effects, for short procedures in general anaesthesia.

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Section: Patients' Ideal Premedication Effectssupporting

confidence: 94%

“…Midazolam has a more potent amnesic effect than most other premedicant drugs (15,16). Whether the patients experience this as beneficial or frightening is an issue of debate (23,24).…”

Section: )mentioning

confidence: 99%

Premedication with midazolam in out‐patient general anaesthesia. A comparison with morphine‐scopolamine and placebo

Ræder¹,

Breivik²

1987

Acta Anaesthesiol Scand

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“…The anaesthesiologists in the presrn t study, however, graded midazolam-premedicated patients as more relaxed than those premedicated with ketobemidone. This is in agreement with previous studies by van Wijhe et al and Vinik et al (15,16), but in contrast to Lundgren, who found morphinescopolamine to be more effective than diazepam when rated by an observer (18).…”

Section: Many Pharmacological and Physiological Argumentssupporting

confidence: 93%

“…This is in accordance with the study of Raeder, who found no difference in anxiolytic properties between midazolam and morphine-scopolamine ( 13). Others have found midazolam to be superior to fentanyl-droperidol and hydroxyzine as premedication (15,16). We could also see a difference in favour of midazolam when those in a subgroup of more tense patients were compared.…”

Section: Many Pharmacological and Physiological Argumentsmentioning

confidence: 61%

“…There were an equal number of patients, from the two premedication groups, who were disappointed with the premedication and who rated a negative reaction described as an increase of anxiety. Negative reactions have been reported after both dixyrazine and fentanyl-droperidol premedication (5,16). One can, of course, question the feasibility of comparison between different drugs used as premedication in this manner, an issue recently discussed by Madej & Paasuke (7).…”

Section: Many Pharmacological and Physiological Argumentsmentioning

confidence: 99%

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Premedication before elective breast surgery, a comparison between ketobemidone and midazolam

Jakobsson

Andersson

Nilsson

et al. 1991

Acta Anaesthesiol Scand

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One hundred female patients scheduled for elective breast surgery (mean age 60 +/- 11 years were randomly assigned to receive one of two premedications: ketobemidone (Ketogan) 1-1.5 ml or midazolam 4-5 mg, intramuscularly. The effects on preoperative anxiety and postoperative emetic sequelae were studied. All patients were anaesthetised with thiopentone, fentanyl and atracurium, and ventilated with a mixture of nitrous oxide in oxygen with supplementary isoflurane. Sixty-nine percent of the midazolam- and 50% of the ketobemidone-premedicated patients experienced a reduction in anxiety. Midazolam was found to be more effective than ketobemidone in reducing anxiety among more tense patients--those with a VAS grading before premedication of 2 or more (P less than 0.05). Midazolam-premedicated patients were also assessed by observers as being more relaxed (P less than 0.05). No difference was seen in the frequency of emetic sequelae: 20 patients in the midazolam group and 14 patients in the ketobemidone group vomited once or more during the 24-h observation period. There was no difference between the two groups in time until an analgetic was required. In conclusion, midazolam seemed more effective in reducing preoperative anxiety than ketobemidone without any negative effects on postoperative emesis or time until an analgetic was required.

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Dose‐Finding and Pharmacokinetic Study of Intramuscular Midazolam

Avram¹,

Fragen²,

Caldwell³

1987

The Journal of Clinical Pharma

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Ten healthy male volunteers received intramuscular (IM) doses of 0.050, 0.075, and 0.100 mg/kg midazolam hydrochloride or its vehicle (placebo) in a double-blind manner until a dose producing adequate preanesthetic sedation was administered. Level of sedation, degree of impairment of psychomotor function, existence of antegrade amnesia, and incidence of side effects were evaluated after each dose. An adequate level of sedation (awake/drowsy or asleep/easily responds to verbal command for at least one hour after drug administration) was produced, beginning shortly after drug administration, in eight of the volunteers by 0.075 mg/kg; the dose producing the same effect (the optimal dose) was 0.050 mg/kg for the oldest volunteer, and the other volunteer required 0.100 mg/kg. Sedation lasted no more than four hours after administration of the optimal dose. The optimal dose in each volunteer produced an impairment of psychomotor function that lasted no more than six hours and antegrade amnesia that lasted no more than two hours. Mild erythema at the injection site occurred infrequently. The pharmacokinetic variables describing the absorption and disposition of midazolam were determined in five of the volunteers. Pharmacokinetic studies indicated that midazolam hydrochloride is absorbed rapidly from IM injection sites; this consistent with the observation of a rapid onset of sedation. The relatively high elimination clearance of midazolam after IM administration is similar to that reported after intravenous administration. The results of this study suggest that midazolam hydrochloride 0.075 mg/kg IM provides sedation and amnesia that is satisfactory for preanesthetic medication but does not last too long into the recovery period.

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Midazolam versus Fentanyl/Droperidol and Placebo as Intramuscular Premedicant

Cited by 14 publications

References 14 publications

Premedication with midazolam in out‐patient general anaesthesia. A comparison with morphine‐scopolamine and placebo

Premedication with midazolam in out‐patient general anaesthesia. A comparison with morphine‐scopolamine and placebo

Premedication before elective breast surgery, a comparison between ketobemidone and midazolam

Dose‐Finding and Pharmacokinetic Study of Intramuscular Midazolam

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