title: The effect of midazolam on stress levels during simulated emergency medical service transport: a placebo-controlled, dose-response study.
abstract: Patients in the emergency medical service (EMS) may have increased endogenous catecholamines because of pain or fear and may benefit from sedation similar to premedication in the hospital. During a simulated EMS scene call, 72 healthy male volunteers were either transported by paramedics from a third-floor apartment through a staircase with subsequent EMS transport with sirens (three stress groups of n = 12; total, n = 36) or asked to sit on a chair for 5 min and lie down on a stretcher for 15 min (three control groups of n = 12; total, n = 36). Catecholamine plasma samples were measured in the respective stress and control groups at baseline and after placebo IV (n = 12) or 25 (n = 12) or 50 (n = 12) microg/kg of midazolam IV throughout the experiment, respectively. Statistical analysis was performed with analysis of variance; P < 0.05 was considered significant. The Placebo Stress versus Control group, but not the 50 microg/kg Stress Midazolam group, had both significantly increased epinephrine (73 +/- 5 pg/mL versus 45 +/- 5 pg/mL; P < 0.001) and norepinephrine (398 +/- 34 pg/mL versus 278 +/- 23 pg/mL; P < 0.01) plasma levels after staircase transport. After EMS transport, the Placebo Stress versus Control group had significantly increased epinephrine (51 +/- 4 pg/mL versus 37 +/- 4 pg/mL; P < 0.05) but not norepinephrine (216 +/- 24 pg/mL versus 237 +/- 18 pg/mL) plasma levels, whereas no significant differences in catecholamine plasma levels occurred between groups after either 25 or 50 microg/kg of midazolam. In conclusion, simulated EMS patients may be subject to more stress during staircase transport than during transport in an EMS vehicle. Titrating sedation with 25 microg/kg of midazolam significantly reduced endogenous catecholamines but not heart rate.
  
  
  CONCLUSIONS
  Simulated emergency medical service patients were more likely to be stressed when being transported by paramedics through a staircase than in an ambulance. Accordingly, it may be beneficial to inject sedative drugs before initiating transport to ensure patient comfort and safety.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Germany. v.doerges@t-online.de
authors.forename: Volker
authors.initials: V
authors.lastname: Dörges
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Susanne
authors.initials: S
authors.lastname: Dix
authors.forename: Alexander
authors.initials: A
authors.lastname: Kühl
authors.forename: Thomas
authors.initials: T
authors.lastname: Schumann
authors.forename: Michael
authors.initials: M
authors.lastname: Hüppe
authors.forename: Heiko
authors.initials: H
authors.lastname: Iven
authors.forename: Klaus
authors.initials: K
authors.lastname: Gerlach
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances; D014151:Anti-Anxiety Agents / Q000097:blood / Q000627:therapeutic use*; D002395:Catecholamines / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004630:Emergencies / Q000523:psychology*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008874:Midazolam / Q000097:blood / Q000627:therapeutic use*; D016544:Patient Simulation; D013312:Stress, Physiological / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014187:Transportation of Patients
chemical_list: D014151:Anti-Anxiety Agents; D002395:Catecholamines; D008874:Midazolam