title: Middle-ear surgery under sedation: comparison of midazolam alone or midazolam with remifentanil.
abstract: OBJECTIVE
  Performance of middle-ear surgery under local anaesthesia has several advantages, but many patients complain of pain, anxiety and adverse events (e.g. dizziness and nausea). To minimise such problems, we compared sedation with midazolam alone versus midazolam with remifentanil.
  
  
  METHODS
  We initially observed 19 patients undergoing middle-ear surgery under local anaesthesia, as controls. We then sedated a further 40 patients undergoing such surgery, with either midazolam or midazolam plus remifentanil.
  
  
  RESULTS
  The sedated patients had significantly lower incidences of local anaesthesia injection pain (p < 0.001), intra-operative pain (p < 0.001), intra-operative anxiety (p < 0.001) and adverse events, compared with the control group. Patients sedated with midazolam plus remifentanil reported less intra-operative anxiety (p = 0.010) and greater post-operative satisfaction with sedation (p = 0.007), compared with those sedated with midazolam only.
  
  
  CONCLUSIONS
  Patients undergoing middle-ear surgery under local anaesthesia alone frequently report pain, anxiety and adverse events. However, the majority of our patients who were sedated with midazolam satisfactorily overcame pain, anxiety and adverse events. Results were better still when midazolam was accompanied by remifentanil.
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Hallym University, Chuncheon, South Korea.
authors.forename: J J
authors.initials: JJ
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control; D016292:Procedural Sedation / Q000379:methods*; D004244:Dizziness / Q000517:prevention & control; D004359:Drug Therapy, Combination; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007271:Injections, Intradermal / Q000009:adverse effects; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D000077208:Remifentanil
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam