title: Midazolam does not antagonize fentanyl-mediated analgesia in surgical patients.
abstract: OBJECTIVE
  To determine whether midazolam possesses a clinically significant antianalgesic action in surgical patients.
  
  
  METHODS
  Randomized, controlled study.
  
  
  METHODS
  Inpatient anesthesia at a university department of neurosurgery.
  
  
  METHODS
  2 groups of 10 patients each who were scheduled for supratentorial brain surgery, did not have elevated intracranial pressure, and were free from systemic disease.
  
  
  METHODS
  Patients underwent anesthesia induction with hexobarbital, succinylcholine, and pancuronium; anesthesia was maintained with injections of droperidol-fentanyl (Group 1) or with midazolam-fentanyl (Group 2) following a predetermined repetitive dosing schedule, such that fentanyl 0.1 mg was injected upon predominant increases in heart rate, whereas droperidol 2.5 mg or midazolam 2.5 mg was injected upon increases in blood pressure.
  
  
  RESULTS
  Duration of anesthesia and invasiveness of surgery were similar in both groups. The amount of fentanyl required was 0.55 +/- 0.18 mg/hr (mean +/- SD) in Group 1 and 0.53 +/- 0.17 mg/hr in Group 2. Injections of droperidol 7.5 +/- 3.4 mg/hr (Group 1) and midazolam 5.9 +/- 2.3 mg/hr (Group 2) were administered intraoperatively. This redosing regimen was associated with uninterrupted hemodynamic stability, indicating comparable and adequate anesthetic depth. Plasma concentrations of metabolites and hormones indicative of humoral stress activation did not differ between groups.
  
  
  CONCLUSIONS
  Under these clinical conditions, the administration of midazolam, when compared with droperidol, was not associated with signs of any antagonistic or antianalgesic action toward fentanyl-mediated analgesia.
authors.affiliation: Department of Anesthesiology and Resuscitation, Johann Wolfgang Goethe University Clinics, Frankfurt a. Main, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Behne
authors.forename: V
authors.initials: V
authors.lastname: Lischke
authors.forename: F
authors.initials: F
authors.lastname: Asskali
authors.forename: S
authors.initials: S
authors.lastname: Probst
authors.forename: R
authors.initials: R
authors.lastname: Hermann
authors.forename: J
authors.initials: J
authors.lastname: Vettermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004329:Droperidol / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D006339:Heart Rate / Q000187:drug effects; D006591:Hexobarbital / Q000008:administration & dosage; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D010197:Pancuronium / Q000008:administration & dosage; D013312:Stress, Physiological / Q000097:blood; D013390:Succinylcholine / Q000008:administration & dosage; D015173:Supratentorial Neoplasms / Q000601:surgery
chemical_list: D000700:Analgesics; D006591:Hexobarbital; D013390:Succinylcholine; D010197:Pancuronium; D004329:Droperidol; D008874:Midazolam; D005283:Fentanyl