Sedation with midazolam for electrical cardioversion.
BACKGROUND
Electrical cardioversion (ECV) usually requires the assistance of the anesthesiology team. To avoid this dependence, previous studies have considered the use of sedation with benzodiazepines administered by cardiologists. We describe our experience with intravenous Midazolam during cardioversion.


METHODS
We performed 280 ECV in 202 patients sedated with intravenous Midazolam, without anesthesiology supervision. In scheduled cardioversions, we tested two protocols of Midazolam administration: a bolus of 3 mg, followed by 2 mg each minute until necessary, and a loading dose of 0.09-0.1 mg/kg. In cardioversions performed during electrophysiology studies or defibrillator implant, Midazolam was administered by small repeated doses during the entire procedure.


RESULTS
Midazolam was effective to obtain adequate sedation in 99% of cases. All patients had amnesia with regards of the cardioversion. A loading dose of Midazolam allowed a shortening of the procedural time without serious adverse events. Intubation or the assistance of an anesthetist was never necessary.


CONCLUSIONS
Sedation with Midazolam for ECV is effective and well tolerated, with some cautions discussed. A loading dose of Midazolam is well tolerated and further reduces the procedural time.
Notarstefano
Pasquale
P
University of Ferrara, Cardiovascular Institute, Ferrara, Italy. notarstefano2001@yahoo.it
Pratola
Claudio
C
Toselli
Tiziano
T
Baldo
Elisa
E
Ferrari
Roberto
R
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D016292:Procedural Sedation / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D008874:Midazolam