Midazolam premedication reduces propofol requirements for sedation during regional anesthesia.
OBJECTIVE
Propofol is often used for sedation during spinal anesthesia. We investigated the effects of midazolam premedication on the propofol requirements and incidence of complications during sedation.


METHODS
In a prospective randomized, controlled, and single-blinded study, 50 patients undergoing elective gynecological surgery were randomly divided into control and midazolam groups. Patients in the midazolam group received 2 mg midazolam im 30 min before arrival at the operation room. After spinal anesthesia was instituted with intrathecal injection of hyperbaric tetracaine, we provided sedation using continuous infusion of propofol. The level of sedation was controlled at a level between "eyes closed but rousable to command" and "eyes closed but rousable to mild physical stimulation" by adjusting the infusion rate. During sedation, the propofol requirements and complications were recorded and patients were asked, two hours after the end of operation, whether they remembered intraoperative events.


RESULTS
In the midazolam group, the loading dose, steady state infusion rate, and overall infusion rate of propofol were 0.74 mg x kg(-1), 2.86 mg x kg(-1) x hr(-1), and 3.32 mg x kg(-1) x hr(-1), respectively, which were about 17% lower than those in the control group (P<0.05). Moreover, midazolam premedication reduced the incidence of intraoperative memory (P < 0.05), but had no effects on other complications.


CONCLUSIONS
Midazolam premedication reduced propofol requirements and the incidence of intraoperative memory during sedation. These effects on sedation using propofol during spinal anesthesia are considered beneficial for patients.
Nakagawa
M
M
Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari, Osaka City, Japan.
Mammoto
T
T
Hazama
A
A
Kita
T
T
Akamatsu
T
T
Kambara
N
N
Sakai
T
T
Kishi
Y
Y
D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D011229:Preanesthetic Medication; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D016037:Single-Blind Method
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol