title: The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles, and perioperative dreams.
abstract: This study examined the effects of midazolam on the doses of propofol required for the induction of hypnosis and the maintenance of propofol/nitrous oxide anesthesia. In addition, the effects of midazolam on the time to patient recovery, perioperative mood profiles, incidence of perioperative dreams, patient satisfaction scores, and requirement for postoperative analgesics were assessed. This investigation was a prospective, randomized, and double-blind study of female patients undergoing dilatation and curettage. Patients received midazolam (30 microg/kg, n = 30) or an equal volume of placebo (n = 30) immediately before the induction of anesthesia. Recall of dreams was assessed immediately postoperatively, in the postanesthesia care unit (PACU), and on the day after surgery using a questionnaire designed for surgical patients. Mood profiles were quantified using the Multiple Affect Adjective Check List-Revised, which was completed preoperatively and 1 h postoperatively. The Client Satisfaction Questionnaire-8, an eight-item self-administered version of the Client Satisfaction Questionnaire, was used to assess patient satisfaction on the day after surgery. Our results indicate that although the time to the loss of the lid reflex was significantly shorter in patients receiving midazolam (43.8 +/- 2.7 vs 74.7 +/- 7.6 s, P < 0.0003), there was no significant difference in the dose of propofol required to induce hypnosis or maintain anesthesia. There were no group differences in postoperative sedation and orientation scores, perioperative mood profiles, incidence of dreams, and patient satisfaction scores. More patients who received midazolam requested analgesics in the PACU (11 vs 4, P < 0.05). In conclusion, midazolam did not reduce the anesthetic dose requirement of propofol in patients undergoing anesthesia with nitrous oxide, nor did it accelerate patient recovery. Our results call into question the benefit of coinducing anesthesia with propofol and midazolam.
  
  
  CONCLUSIONS
  Midazolam, administered immediately before anesthetic induction with propofol, did not decrease the dose of propofol necessary for hypnosis, nor the maintenance of surgical anesthesia, in female patients undergoing diagnostic dilatation and curettage. In addition, midazolam did not alter patient recovery characteristics, postoperative mood, incidence of perioperative dreams, or patient satisfaction. The use of midazolam was associated with an increased need for postoperative analgesics. Our study calls into question the benefit of administering midazolam immediately before anesthetic induction with propofol.
authors.affiliation: Department of Anaesthesia, Sunnybrook Health Science Center and the Faculty of Medicine, University of Toronto, Ontario, Canada. donald.oxorn@utoronto.ca
authors.forename: D C
authors.initials: DC
authors.lastname: Oxorn
authors.forename: L E
authors.initials: LE
authors.lastname: Ferris
authors.forename: E
authors.initials: E
authors.lastname: Harrington
authors.forename: B A
authors.initials: BA
authors.lastname: Orser
mesh_terms: D000339:Affect / Q000187:drug effects*; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D004311:Double-Blind Method; D004325:Dreams / Q000187:drug effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D011939:Mental Recall; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D017060:Patient Satisfaction; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol