title: Predominant effects of midazolam for conscious sedation: benefits beyond the early postoperative period.
abstract: OBJECTIVE
  Conscious sedation with intravenous sedative-hypnotic drugs has the advantage of relaxing patients before invasive procedures. Preoperative anxiety has been suggested to correlate with postoperative comfortableness. In this study, we chose midazolam and droperidol as well-established intravenous sedative-hypnotic drugs. We evaluated the preoperative anxiolytic effect on postoperative memories and emotions up to the first postoperative morning.
  
  
  METHODS
  In a prospective, double blind study, 120 patients requiring epidural anesthesia were randomly assigned to one of three groups to receive saline, midazolam (0.04 mg/kg), or droperidol (0.1 mg/kg). Cardiovascular and respiratory measurements, observer's assessment of alertness/sedation scale, level of anxiety and discomfort of the patients, pain during the infiltration of local anesthetics, and incidence of adverse effects were recorded. Amnesia, anxiety, and discomfort during the epidural procedure were re-assessed between 12 and 20 h postsurgery.
  
  
  RESULTS
  Patients who received sedatives were significantly more sedated (P < 0.0001), but the pain score was significantly higher in the droperidol group (P = 0.0007) at epidural catheterization. On the first postoperative morning, patients receiving midazolam had a significantly lower pain score (P < 0.0001) with less anxiety and discomfort. Patients in both the midazolam and droperidol groups showed a significant decrease in blood pressure (P < 0.0167), but no respiratory impairment. No adverse effects were experienced throughout the study period.
  
  
  CONCLUSIONS
  Conscious sedation with intravenous midazolam 0.04 mg/kg significantly decreased the anxiety and discomfort scores of the patients on the day following surgery but had no effect on these immediately following the epidural catheterization procedure.
authors.affiliation: Department of Anesthesia, Kosei General Hospital, Tokyo, Japan. macaroon@nifty.com
authors.forename: Kotoe
authors.initials: K
authors.lastname: Kamata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hagihira
authors.forename: Ryu
authors.initials: R
authors.lastname: Komatsu
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D011182:Postoperative Care; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008874:Midazolam; D010100:Oxygen