Predominant effects of midazolam for conscious sedation: benefits beyond the early postoperative period

Kamata, Kotoe; Hagihira, Satoshi; Komatsu, Ryu; Ozaki, Makoto

doi:10.1007/s00540-010-1017-z

Cited by 4 publications

(4 citation statements)

References 31 publications

(39 reference statements)

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“…The anxiolytic was advised in low dose to achieve conscious sedation, resulting in stress relief while providing the easily controllable level of sedation, anterograde amnesia, rapid and clear-headed recovery and with no side effects. [ 28 29 ]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of salivary alpha-amylase levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery

Bano

Garg

Agrawal

et al. 2021

Int J App Basic Med Res

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Aims and Objectives: To evaluate salivary alpha-amylase (sAA) levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery. Materials and Methods: One hundred and twenty subjects (age 18–65 years) planned for infra-umbilical surgery under spinal anesthesia were included and allocated to Groups A and B ensuring age and sex matching. In both groups, sAA levels (S1 to S4) were assessed sequentially at different times (E1 to E4). S1 and S2 were collected on the evening before surgery (E1) and in the preoperative room on the day of surgery (E2), respectively. Thereafter, in Group A, S3 and S4 were collected before (E3) and 15 min after spinal anesthesia (E4), following which intravenous Midazolam was given. In Group B, intravenous Midazolam was administered first, S3 was collected 5 min later (E3), spinal anesthesia was administered and S4 was collected after15 min (E4). Results: In both groups, sAA levels showed a mild increase from E1 to E2 (not significant). Thereafter from E2 to E3 and E3 to E4, a significant sharp rise in sAA levels in Group A and a significantly acute decline in Group B was noted. Mean sAA levels in Group A were higher as compared to group B ( P < 0.005) in E3 and E4. Conclusion: Sequential documentation of increase in sAA levels in our study, starting with the baseline levels, presents a comprehensive report of the stress that the patients experience during preoperative period and reinforces the need of anxiolytic before spinal anesthesia.

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Section: Discussionmentioning

confidence: 99%

Evaluation of salivary alpha-amylase levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery

Bano

Garg

Agrawal

et al. 2021

Int J App Basic Med Res

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“…Fear and anxiety alter patients' perception of pain, especially in children, and the combination of anxiolytics, behaviour modification and benzodiazepines, such as midazolam, may be an important adjuvant to skin infiltration with buffered lidocaine to improve patient and parent satisfaction (11,12). Topical local anaesthetics can be used for repair of dermal lacerations, placement of epidural catheters and spinal puncture; however, infiltration with lidocaine is usually required for optimal analgesia (13).…”

Section: Commentary By Todd J Kilbaughmentioning

confidence: 99%

Commentary on ‘Adjusting the pH of lidocaine for reducing pain on injection’

Kilbaugh

2012

Evid.‐Based Child Health

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This is a commentary of Cochrane review, published in this issue of EBCH, first published as: Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD006581. DOI:10.1002/14651858.CD006581.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

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“…It has been shown that the preprocedural anxiety level correlates with the postprocedural level of patient comfort. One study compared the anxiolytic effect of midazolam and droperidol, administered prior to epidural catheterization, on postprocedural memories and comfort level between 12 and 20 hours and showed that patients receiving midazolam reported significantly less pain and anxiety (16).…”

Section: Indications For Procedural Sedation Analgesiamentioning

confidence: 99%

An Update of Evaluation of Intravenous Sedation on Diagnostic Spinal Injection Procedures

Smith

Colson²,

Sehgal³

2013

Pain Phys

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Background: Intravenous (IV) sedation analgesia is often employed in patients with chronic spinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenous sedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation, and analgesia. The very nature of these pharmacologic effects in altering the patient’s level of consciousness, awareness, or response to a particular diagnostic stimulus invokes a sense of uncertainty about the results or response obtained from the diagnostic procedure. There is an ongoing controversy regarding the validity of controlled diagnostic blocks due to variability in sensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the use of sedation analgesic measures prior to controlled diagnostic blocks and their influence on the accuracy and validity of a diagnosis. Objective: To assess and update the clinically significant effects sedation analgesia procedures have on the diagnostic accuracy and validity of interventional spinal techniques. Methods: A comprehensive literature search using PubMed, EMBASE, and Cochrane Library review databases up to September 2012 was performed. The search included systematic and narrative review articles, prospective and retrospective studies, as well as cross-referencing of bibliographies from notable primary and review articles and abstracts from scientific meetings and peer-reviewed non-indexed journals. The search emphasized the effects of sedation analgesia on diagnostic spinal interventions. Conclusion: Based on a review of the available evidence, it appears that the administration of mild to moderate sedation does not confound the results or diagnostic validity of spinal injection procedures. Specifically, immediate pain relief after cervical and lumbar facet joint controlled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This is especially true if stringent outcome criteria are employed, such as at least 75% pain relief combined with an increase in range of motion for pain limited movements. Key words: Conscious sedation, procedural sedation, intravenous sedation, analgesia, hypnotics, sedatives, anxiolytics, opioids, chronic spinal pain, spinal injections, epidural injections, controlled diagnostic nerve blocks, zygapophyseal or facet joint blocks, selective nerve root blocks, provocation discography, sacroiliac joint injections, outcomes

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Predominant effects of midazolam for conscious sedation: benefits beyond the early postoperative period

Abstract: Conscious sedation with intravenous midazolam 0.04 mg/kg significantly decreased the anxiety and discomfort scores of the patients on the day following surgery but had no effect on these immediately following the epidural catheterization procedure.

Cited by 4 publications

References 31 publications

Evaluation of salivary alpha-amylase levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery

Evaluation of salivary alpha-amylase levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery

Commentary on ‘Adjusting the pH of lidocaine for reducing pain on injection’

An Update of Evaluation of Intravenous Sedation on Diagnostic Spinal Injection Procedures

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