Sedative infusions during local and regional anesthesia: a comparison of midazolam and propofol.
OBJECTIVE
To compare the intraoperative effects and recovery characteristics when either midazolam or propofol was used for sedation during local or regional anesthesia.


METHODS
Open-label, randomized study with blinded observer assessing recovery data.


METHODS
Outpatients undergoing elective surgical procedures under local or regional anesthesia at Stanford University Hospital, Stanford, California.


METHODS
Sixty-eight consenting, unpremedicated ASA physical status I, II, or III patients.


METHODS
After achieving adequate analgesia with local anesthetic solutions, patients were administered a loading dose of either midazolam (4.2 +/- 1.4 mg) or propofol (69 +/- 23 mg) followed by a variable-rate maintenance infusion equal to 8.6 +/- 5.4 mg/h or 265 +/- 185 mg/h, respectively, to maintain a stable level of sedation during the operation.


RESULTS
Intraoperative assessments included level of sedation, as well as cardiovascular and respiratory status, at 1- to 5-minute intervals during the operation. Postoperatively, recovery of cognitive and psychomotor function was assessed using analog scales and the digit-symbol substitution test. The overall quality of intraoperative sedation was similar in the two sedative treatment groups. Although midazolam produced less pain on injection and more effective intraoperative amnesia, use of propofol was associated with less postoperative sedation, drowsiness, confusion, clumsiness, and amnesia, as well as more rapid recovery of cognitive function. However, discharge times were similar in the two sedative treatment groups.


CONCLUSIONS
Propofol infusion is a clinically useful alternative to midazolam for sedation during ambulatory surgery under local or regional anesthesia.
White
P F
PF
Department of Anesthesiology, Washington University School of Medicine, St. Louis 63110.
Negus
J B
JB
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural; D000772:Anesthesia, Local; D000775:Anesthesia, Spinal; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*
D008874:Midazolam; D015742:Propofol