Sedative and cardiovascular effects of midazolam and diazepam alone or combined with clonidine in patients undergoing hemodynamic studies for suspected coronary artery disease.
BACKGROUND
Sedation during coronary angiography has been rarely studied, and it is important to know which drug is the best to sedate these patients.


OBJECTIVE
To evaluate the quality of sedation and the effects of midazolam and diazepam alone or combined with clonidine on the heart rate (HR) and blood pressure (BP) of patients with suspected coronary artery disease.


METHODS
This is a controlled, randomized, double-blind, prospective clinical study of 160 patients divided into five groups of 32 patients each, according to the drug used: group C (clonidine 0.5 microg/kg); group M (midazolam 40 microg/kg); group MC (combination of midazolam 40 microg/kg and clonidine 0.5 microg/kg); group D (diazepam 40 microg/kg); and group DC (combination of diazepam 40 microg/kg and clonidine 0.5 microg/kg). Sedation was evaluated based on the Ramsay scale and on the use of meperidine 0.04 mg.kg-1. Invasive BP monitoring, HR and the sedation score were analyzed every five minutes at four different time points.


RESULTS
Patients who received midazolam presented higher sedation scores as well as HR and BP variation (p < 0.05). Those who received diazepam or clonidine had lower sedation scores, which were more satisfactory for the performance of the procedure, and presented a lower BP and HR variation (p > 0.05).


CONCLUSIONS
Midazolam was associated with a greater sedative and cardiovascular effect, whereas for diazepam these effects were less intense. Clonidine and diazepam had similar effects on BP, HR and sedation.
Nascimento
Jedson dos Santos
Jdos S
Hospital Santa Izabel, Salvador, BA, Brasil. jedsonnascimento@terra.com.br
Modolo
Norma Sueli Pinheiro
NS
Silva
Roberto Cruz Rocha
RC
Santos
Kleber Pimentel
KP
Carvalho
Heitor Ghissoni de
HG
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D002932:Cineangiography; D003000:Clonidine / Q000494:pharmacology*; D016292:Procedural Sedation / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis*; D003975:Diazepam / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D003000:Clonidine; D003975:Diazepam; D008874:Midazolam