Oral medication with diazepam or midazolam associated or not with clonidine for oculoplastic office surgery under local anesthesia.
OBJECTIVE
To compare the level of sedation of oral administration of diazepam or midazolam associated or not with clonidine and their effects on upper eyelid margin position, heart rate, arterial pressure, and oxygen saturation.


METHODS
Seventy consecutive healthy patients American Society of Anesthesiologists (ASA) grade I-II scheduled for lower eyelid blepharoplasty were randomized into 4 groups according to the oral sedative agent used (group 1, diazepam 10 mg; group 2, diazepam 10 mg plus clonidine 0.15 mg; group 3, midazolam 15 mg; group 4, midazolam plus clonidine 0.15 mg). For all patients, the midpupil-to-upper eyelid margin distance, the heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded before and 1 hour after the administration of oral medication. The level of sedation at the time of surgery was measured with the Michigan University scale.


RESULTS
The depth of sedation was significantly more pronounced with midazolam (median score = 2) than with diazepam (median score = 1). Clonidine slightly increased the level of sedation of both diazepam and midazolam. The diastolic arterial blood pressure drop with midazolam associated or not with clonidine was significantly greater than with diazepam. The mean upper eyelid margin position shift (-1.42 mm) verified when clonidine was associated with midazolam was also significantly greater than with diazepam.


CONCLUSIONS
Oral sedation with diazepam or midazolam associated or not with clonidine is safe for ASA grade I-II patients. The systemic effects of diazepam and midazolam were small and very similar. The sedation induced by midazolam was clearly greater than that induced by diazepam. However, this higher level of sedation was accompanied by a more important shift in upper eyelid margin position.
Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Victor Marques
VM
de Alencar
Rejane Dantas Rodrigues
RD
Gonçalves
Antonio Augusto Velasco
AA
Cruz
D000284:Administration, Oral; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local; D019882:Blepharoplasty; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000008:administration & dosage*; D016292:Procedural Sedation; D003975:Diazepam / Q000008:administration & dosage*; D004338:Drug Combinations; D005143:Eyelids / Q000601:surgery; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D011229:Preanesthetic Medication
D000700:Analgesics; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D003000:Clonidine; D003975:Diazepam; D008874:Midazolam