title: Midazolam changes cerebral blood flow in discrete brain regions: an H2(15)O positron emission tomography study.
abstract: BACKGROUND
  Changes in regional cerebral blood flow (rCBF) determined with H2(15)O positron emission tomographic imaging can identify neural circuits affected by centrally acting drugs.
  
  
  METHODS
  Fourteen volunteers received one of two midazolam infusions adjusted according to electroencephalographic response. Low or high midazolam effects were identified using post-hoc spectral analysis of the electroencephalographic response obtained during positron emission tomographic imaging based on the absence or presence of 14-Hz spindle activity. The absolute change in global CBF was calculated, and relative changes in rCBF were determined using statistical parametric mapping with localization to standard stereotactic coordinates.
  
  
  RESULTS
  The low-effect group received 7.5 +/- 1.7 mg midazolam (serum concentrations, 74 +/- 24 ng/ml), and the high-effect group received 9.7 +/- 1.3 mg midazolam (serum concentrations, 129 +/- 48 ng/ml). Midazolam decreased global CBF by 12% from 39.2 +/- 4.1 to 34.4 +/- 6.1 ml x 100 g(-1) x min(-1) (P < 0.02 at a partial pressure of carbon dioxide of 40 mmHg). The rCBF changes in the low-effect group were a subset of the high-effect group. Decreased rCBF (P < 0.001) occurred in the insula, the cingulate gyrus, multiple areas in the prefrontal cortex, the thalamus, and parietal and temporal association areas. Asymmetric changes occurred, particularly in the low-effect group, and were more significant in the left frontal cortex and thalamus and the right insula. Relative rCBF was increased in the occipital areas.
  
  
  CONCLUSIONS
  Midazolam causes dose-related changes in rCBF in brain regions associated with the normal functioning of arousal, attention, and memory.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center and Cornell University Medical College, New York, New York 10021, USA. veselisr@mskcc.org
authors.forename: R A
authors.initials: RA
authors.lastname: Veselis
authors.forename: R A
authors.initials: RA
authors.lastname: Reinsel
authors.forename: B J
authors.initials: BJ
authors.lastname: Beattie
authors.forename: O R
authors.initials: OR
authors.lastname: Mawlawi
authors.forename: V A
authors.initials: VA
authors.lastname: Feshchenko
authors.forename: G R
authors.initials: GR
authors.lastname: DiResta
authors.forename: S M
authors.initials: SM
authors.lastname: Larson
authors.forename: R G
authors.initials: RG
authors.lastname: Blasberg
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004569:Electroencephalography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D010104:Oxygen Radioisotopes; D014055:Tomography, Emission-Computed
chemical_list: D006993:Hypnotics and Sedatives; D010104:Oxygen Radioisotopes; D008874:Midazolam