title: The endocrine stress response after oral premedication with low-dose midazolam for intraocular surgery in retrobulbar anaesthesia.
abstract: OBJECTIVE
  It was the purpose of this study to examine the endocrine stess response in patients undergoing elective intraocular surgery in retrobulbar anaesthesia (RBA), and the effect of an oral premedication with 3.75 mg midazolam on this reaction.
  
  
  METHODS
  In a prospective double-blind study, 23 patients were randomly assigned to either group I (n = 12), receiving 3.75 mg midazolam, or group II (n = 11), receiving a matched placebo 60 min before RBA. Plasma concentrations of known mediators of the endocrinological stress response were analysed at five perioperative times: adrenocorticotropic hormone (ACTH), cortisole (CORT), somatotropic hormone (STH), epinephrine (EPI), norepinephrine (NOR), and dopamine (DOP).
  
  
  RESULTS
  The observed endocrinological reaction was moderate. Perioperative anxiety and, above all, RBA were the main stressors. The endocrine stress response could best be seen within the fast-reacting sympathoadrenergic system. Midazolam significantly suppressed the epinephrine and the cortisole answer (p < 0.01). After RBA an ACTH plasma peak only was observed after placebo. Plasma-STH showed extreme variability. An STH-peak after midazolam is presumably due to a gonadotropic hormone-releasing hormone (GHRH) secretion directly stimulated by midazolam. Midazolam had no significant effect upon norepinephrine. A significant (p < 0.01) increase for plasma-cortisole was seen 60 min after the operation when compared to preoperative values.
  
  
  CONCLUSIONS
  The results indicate that even at a low dose midazolam positively influences the endocrine stress response. The combination of this stress-reducing effect with the well-known hemodynamic stability, the distinct anxiolytic and sedative action, suggest low-dose midazolam as a favourable premedication for intraocular surgery.
authors.affiliation: Department of Anaesthesiology, Eberhard-Karls-University, Tübingen, Germany. Thomas.Kiefer@Uni-Tuebingen.de
authors.forename: R T
authors.initials: RT
authors.lastname: Kiefer
authors.forename: J
authors.initials: J
authors.lastname: Weindler
authors.forename: K W
authors.initials: KW
authors.lastname: Ruprecht
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002395:Catecholamines / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D004311:Double-Blind Method; D004703:Endocrine System / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007267:Injections; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D016343:Monitoring, Intraoperative; D009479:Neuropeptides / Q000097:blood; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit; D011229:Preanesthetic Medication; D011292:Premedication; D011446:Prospective Studies; D011863:Radioimmunoassay; D013312:Stress, Physiological / Q000097:blood*
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D002395:Catecholamines; D009479:Neuropeptides; D008874:Midazolam; D006854:Hydrocortisone