title: Oral premedication with low dose midazolam modifies the immunological stress reaction after the setting of retrobulbar anaesthesia.
abstract: OBJECTIVE
  An acute immunological stress reaction was previously reported to occur after the painful setting of retrobulbar anaesthesia before intraocular surgery. This study was conducted to find out whether an oral low dose premedication with midazolam would modify the immunological stress reaction.
  
  
  METHODS
  32 patients undergoing intraocular surgery using retrobulbar anaesthesia were included in a randomised, double blind trial. They received premedication with either 3.75 mg midazolam or placebo 30 minutes before the retrobulbar injection. Counts of leucocyte subpopulations, cardiovascular, and psychometric parameters were measured repetitively before and after the retrobulbar injection.
  
  
  RESULTS
  The numbers of leucocytes increased significantly in the placebo group after the setting of retrobulbar anaesthesia (before retrobulbar injection: 6687 (SD 1025) cells x10(6)/l; after injection: 7067 (1022) cells x10(6)/l, p=0.0009) caused by rising numbers of neutrophils (before injection: 4111 (1063) cells x10(6)/l; after injection: 4352 (1147) cells x10(6)/l, p=0.0007) and natural killer cells (before injection: 290 (84) cell x10(6)/l; after injection 354 (133) cells x10(6)/l, p=0.003). There was no significant increase in total leucocytes (before injection: 5997 (1288) cells x10(6)/l; after injection: 6189 (1215) cells x10(6)/l) or in any leucocyte subpopulation in the midazolam group. A significant rise in systolic blood pressure occurred in the placebo group, but not in the midazolam group.
  
  
  CONCLUSIONS
  A low dose premedication with midazolam attenuates the immunological and cardiovascular stress reactions occurring with retrobulbar anaesthesia.
authors.affiliation: Department of Nephrology, University of Saarland, Homburg, Germany. inghei@uniklinik-saarland.de
authors.forename: G H
authors.initials: GH
authors.lastname: Heine
authors.forename: J
authors.initials: J
authors.lastname: Weindler
authors.forename: H H W
authors.initials: HH
authors.lastname: Gabriel
authors.forename: W
authors.initials: W
authors.lastname: Kindermann
authors.forename: K W
authors.initials: KW
authors.lastname: Ruprecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D001007:Anxiety / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007958:Leukocyte Count; D016131:Lymphocyte Subsets / Q000187:drug effects; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D013312:Stress, Physiological / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D014151:Anti-Anxiety Agents; D008874:Midazolam