Pharmacokinetics of Midazolam in Total I. V. Anaesthesia

Persson, Peter M.; Nilsson, Anders; Hartvig, Per; Tamsen, A.

doi:10.1093/bja/59.5.548

Cited by 71 publications

(29 citation statements)

References 13 publications

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“…Midazolam was infused at 0.68mg.kg-l.h 1 for 15min followed by 0.125mg. kg ~.h -~ according to the method of Persson et al [6], with its infusion being stopped about 30min before the end of surgery. Fentanyl and pancuronium were intermittently administered as necessary.…”

Section: Methodsmentioning

confidence: 99%

Liver and renal functions following total intravenous anesthesia using midazolam and fentanyl—comparison with enflurane-nitrous oxide anesthesia

Nishiyama

Iwasaki

1995

J Anesth

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Thirty patients undergoing lower abdominal surgery were studied to compare liver and renal functions in total intravenous anesthesia (TIVA) using midazolam and fentanyl with those in enflurane-nitrous oxide anesthesia (GOE).Patients were randomly divided into two groups of 15. In the TIVA group, anesthesia was induced with 0.3 mg·kg(-1) midazolam and maintained with 0.68 mg·kg(-1)·h(-1) midazolam for 15 min followed by 0.125 mg·kg(-1)·h(-1) midazolam and fentanyl. In the GOE group, anesthesia was induced with 5 mg·kg(-1) thiamylal and maintained with enflurane-nitrous oxide in oxygen. Plasma levels of aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase, total bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), and creatinine (Cr) were measured before and at 1, 7, and 30 days after surgery. There were transient increases beyond the normal range in ALT and γ-GTP in both groups. BUN and Cr were within the normal range. There were no differences between the two groups regarding these parameters and the numbers with abnormally high levels of each parameter. In conclusion, liver and renal functions following TIVA using midazolam and fentanyl were the same as those following enflurane-nitrous oxide anesthesia.

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Section: Methodsmentioning

confidence: 99%

Liver and renal functions following total intravenous anesthesia using midazolam and fentanyl—comparison with enflurane-nitrous oxide anesthesia

Nishiyama

Iwasaki

1995

J Anesth

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“…During the infusion phase, bias was -0.3% (precision 24.9%) and during the recovery phase, bias was -5.6% (precision 24.7%). In individuals, precision during the infusion phase was 8.9% (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (precision 28.5%), and during the recovery phase, bias was 5.4% (precision 26.6%). In individuals, precision during the infusion phase was 9.8% (range 1-20.7).…”

Section: Resultsmentioning

confidence: 99%

“…Retrospective modelling of the data set using an alternative set of pharmacokinetic parameters for midazolam derived from patients undergoing major surgery was also performed and compared similarly [7].…”

Section: Discussionmentioning

confidence: 99%

“…When the pharmacokinetic data set from Persson et al [7] was modelled retrospectively, bias and precision of the model deteriorated significantly, the source of increased error being mostly due to the more rapid transfer to the peripheral compartment and excretion. Again the model was more successful at maintaining a constant plasma concentration.…”

Section: Discussionmentioning

confidence: 99%

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Pharmocokinetic model‐controlled infusion of midazolam

et al. 1993

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SummaryThe accuracy of a computer-controlled infusion of midazolam. based on previously published pharmacokinetic parameters, was tested prospectively in 12 adult female patients undergoing general anaesthesia. Anaesthesia consisted of an initial bolus followed by an exponetially decreasing infusion of midazolam given according to body weight, fentanyl, nitrous oxide and vecuronium. Venous blood samples were taken at 15 min-intervals throughout the procedures and for 1-2 h postoperatively. The bias of the model was -5.1% (95% CI -11.3 to 1.2%) andprecision 24.8% (9S%CI 20.9 to 28.6%). Least squares regression analysis decreased the bias to -2.8% but did not alter precision. Retrospective fitting of an alternative set of published parameters for midazolam resulted in significant deterioration of the model. The precision was similar to that found in past studies of intravenous anaesthetic agents. Further improvement in the accuracy of midazolam infusion awaits improved understanding of the causes of pharmocokinetic variability.

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“…Despite this, the drug has been used successfully for TIVA, with opioid supplementation with or without nitrous oxide. 6 Ketamine has potent analgesic properties besides its anaesthetic potency. It is not suitable for the maintenance of anaesthesia in TIVA, as it has a long recovery period due to drug accumulation and active metabolites.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the gravimetric method of propofol infusion with intermittent ketamine injections for total intravenous anaesthesia (TIVA)

Amadasun¹,

Edomwonyi²

2009

Journal of Medicine and Biomedical Research

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Forty four patients scheduled for elective surgery of short to moderate duration (< 90 minutes) were recruited into this study. Anaesthesia was induced with intravenous propofol 2.5mg/kg and maintained with continuous intravenous infusion of pre-mixed propofol and normal saline containing 2mg/ml of propofol. Suxamethonium 1mg/kg was used to facilitate endotracheal intubation. No long-acting muscle relaxant was used. Intravenous ketamine 0.5mg/kg stat dose was given for analgesic supplement, and 0.25mg/kg subsequent intermittent doses on signs of inadequate anaesthesia. The propofol infusion was stopped at the end of the surgery. Mean duration of anaesthesia was 56.5 ± 2.6 minutes while mean recovery time was 10.6 ± 4.6 minutes. The mean post-anaesthetic recovery scores (PARS) were 4.35/6, 5.17/6, 5.80/6 and 5.85/6 at admission to the recovery room and after 15 minutes, 30 minutes and discharge to the ward respectively. There were no incidents of extreme haemodynamic fluctuations or emergence phenomena noticed in any of the patients.

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Pharmacokinetics of Midazolam in Total I. V. Anaesthesia

Cited by 71 publications

References 13 publications

Liver and renal functions following total intravenous anesthesia using midazolam and fentanyl—comparison with enflurane-nitrous oxide anesthesia

Liver and renal functions following total intravenous anesthesia using midazolam and fentanyl—comparison with enflurane-nitrous oxide anesthesia

Pharmocokinetic model‐controlled infusion of midazolam

Evaluation of the gravimetric method of propofol infusion with intermittent ketamine injections for total intravenous anaesthesia (TIVA)

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