Continuous infusion of midazolam or bolus of diazepam for postoperative sedation in cardiac surgical patients.
Sedation and recovery were studied in 14 patients requiring overnight ventilation in the ICU after aortocoronary bypass surgery performed under high-dose fentanyl anesthesia (120 micrograms/kg). Patients received either IV bolus of diazepam (group D) or a combination of IV bolus with a continuous infusion of midazolam (group M). In the 2 groups, an on-demand mode of administration was used to provide optimal sedation. In the ICU, dosages of plasma catecholamines and serum benzodiazepines were performed. After cessation of benzodiazepine administration at midnight, the rapidity of recovery and time of extubation were recorded. Results showed that in the 2 groups, the association of a high-dose fentanyl anesthesia with a profound postoperative sedation maintained the epinephrine and norepinephrine concentrations at low levels during the whole postoperative period. After benzodiazepine discontinuation, recovery and extubation were faster in group M, which correlated with the significant decrease (p less than 0.05) in blood concentration of midazolam observed the first postoperative day whereas at the same time the blood concentration of diazepam did not fall significantly.
Barvais
L
L
Department of Anesthesia, Hôpital académique Erasme, Bruxelles, Belgique.
Dejonckheere
M
M
Dernovoi
B
B
Stenier
P
P
Bastenier
J
J
D000328:Adult; D000762:Anesthesia Recovery Period; D001569:Benzodiazepines / Q000097:blood; D002395:Catecholamines / Q000097:blood; D001026:Coronary Artery Bypass; D003975:Diazepam / Q000008:administration & dosage* / Q000097:blood; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008874:Midazolam / Q000008:administration & dosage* / Q000097:blood; D008875:Middle Aged
D002395:Catecholamines; D001569:Benzodiazepines; D003975:Diazepam; D008874:Midazolam; D005283:Fentanyl