title: Midazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization.
abstract: Preoperatively administered midazolam may contribute to postoperative sedation and delayed recovery from brief outpatient general anesthesia, particularly in patients who receive significant postoperative opioid analgesics. We evaluated the effects of midazolam premedication (0.04 mg/kg) on postoperative sedation and recovery times after laparoscopic tubal sterilization (Falope rings) in 30 healthy women in a randomized, double-blind, placebo-controlled study. Patients received midazolam or saline-placebo intravenously 10 min before anesthesia. General anesthesia was induced with fentanyl, propofol, and mivacurium and was maintained with N2O and isoflurane. Sedation was quantified before and after premedication and 15, 30, and 60 min after emergence from anesthesia, using the digit-symbol substitution (DSST) and Trieger dot (TDT) tests. Management of postoperative pain and nausea and discharge criteria were standardized. Groups were similar with respect to age, weight, and duration of surgery and anesthesia. Midazolam was associated with impairment of performance on the TDT and DSST after premedication administration and 15 (TDT and DSST) and 30 (DSST) min after postanesthesia care unit (PACU) arrival. There were no differences in PACU time and time to discharge-readiness. In conclusion, midazolam premedication augments postoperative sedation in this population but does not prolong recovery times.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, New York 14642, USA. mrichardson@anes.rochester.edu
authors.forename: M G
authors.initials: MG
authors.lastname: Richardson
authors.forename: C L
authors.initials: CL
authors.lastname: Wu
authors.forename: A
authors.initials: A
authors.lastname: Hussain
mesh_terms: D000328:Adult; D000367:Age Factors; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000932:Antiemetics / Q000627:therapeutic use; D001835:Body Weight; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007530:Isoflurane / Q000008:administration & dosage; D007546:Isoquinolines / Q000008:administration & dosage; D010535:Laparoscopy; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D000077590:Mivacurium; D009325:Nausea / Q000188:drug therapy; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy; D010351:Patient Discharge; D010919:Placebos; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D013246:Sterilization, Tubal; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D000932:Antiemetics; D006993:Hypnotics and Sedatives; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D010919:Placebos; D000077590:Mivacurium; D007530:Isoflurane; D009609:Nitrous Oxide; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol