Low-dose midazolam infusion for oculoplastic surgery under local anesthesia.
OBJECTIVE
Oculoplastic surgery with infiltration of local anaesthesia at the operative site performed as a day-case procedure is both efficient and cost-effective. Patients considered unsuitable for this because of fear or apprehension may, however, benefit from per-operative conscious sedation. We sought to study the efficacy and safety of this using midazolam, a water-soluble benzodiazepine.


METHODS
We have performed a controlled clinical trial comparing the effect of a low-dose intravenous infusion of midazolam (0.2 mg/ml of normal saline at a rate of 1 mg/h) with saline placebo on 48 subjects undergoing oculoplastic surgery with local anaesthesia. Patients were given pre- and post-operative questionnaires assessing, amongst other factors, anxiety levels, pain, degree of reported amnesia and psychomotor recovery.


RESULTS
Using the low-dose midazolam infusion no adverse cardiorespiratory reactions occurred. Patients receiving midazolam reported remembering significantly less about their operation than controls (p = 0.04) and showed significantly lower state-anxiety after their operation than before (p < 0.02). This change was not noted in the placebo group. There was no significant difference in the psychomotor performance of patients given midazolam compared with controls 2 h after surgery.


CONCLUSIONS
A low-dose continuous infusion of midazolam can be used to safely provide effective anxiolysis and conscious sedation with good psychomotor recovery during oculoplastic procedures in a day-case setting.
Biswas
S
S
Manchester Royal Eye Hospital, UK.
Bhatnagar
M
M
Rhatigan
M
M
Kincey
J
J
Slater
R
R
Leatherbarrow
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D014151:Anti-Anxiety Agents; D016292:Procedural Sedation / Q000379:methods; D004334:Drug Administration Schedule; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D016037:Single-Blind Method
D014151:Anti-Anxiety Agents; D008874:Midazolam