A comparison of midazolam with trimeprazine as an oral premedicant for children

The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg⁻¹ given 30 min pre-operatively was compared with trimeprazine 2 mg.kg⁻¹ given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p =0.0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.     

Management of status dystonicus: our experience and review of the literature.

Status dystonicus (SD) is a life threatening disorder that develops in patients with both primary and secondary dystonia, characterized by acute worsening of symptoms with generalized and severe muscle contractions. To date, no information is available on the best way to treat this disorder. We review the previously described cases of SD and two new cases are reported, one of which occurring in a child with static encephalopathy, and the other one in a patient with pantothenate kinase-associated neurodegeneration. Both patients were admitted to an intensive care unit and treated with midazolam and propofol. This approach proved to be useful in the former while the progressive nature of the dystonia of the second patient required the combination of intrathecal baclofen infusion and bilateral pallidal deep brain stimulation. We believe that a rapid and aggressive approach is justified to avoid the great morbidity and mortality which characterize SD. Our experience, combined with the data available in the literature, might permit to establish the best strategies in managing this rare and severe condition.     

Comparison of propofol induction with thiopentone or methohexitone in short outpatient general anaesthesia

The per- and post-operative characteristics of three different i.v. anaesthetic induction agents were studied double-blindly in 75 patients admitted for outpatient gynaecological dilatation and curettage. All the patients were premedicated with midazolam 0.1 mg/kg i.m. Induction started with alfentanil 0.015 mg/kg i.v. 60 s before either: propofol 2.2 mg/kg i.v., or thiopentone 4.0 mg/kg i.v., or methohexitone 2.0 mg/kg i.v. All the patients received 66% nitrous oxide in oxygen. The propofol patients were significantly better relaxed and had a higher incidence of hypotension during the procedure. The methohexitone patients had higher pulse rates and a higher frequency of hiccups during the procedure. Propofol induction resulted in a faster awakening of the patients and a better recovery function compared with methohexitone for the first 15 min and compared with thiopentone for the first 240 min after the procedure. Postoperative side-effects were less frequent in the thiopentone group, and minor abdominal pain was significantly more frequent in the propofol group. There was no significant difference between the groups for any variable after 240 min postoperatively.     

咪唑安定对布比卡因蛛网膜下腔麻醉效果的影响

目的观察咪唑安定加入布比卡因对蛛网膜下腔麻醉维持时间和麻醉效果的影响。方法40例ASAⅠ级子宫切除病人随机分为咪唑安定组（试验组，11=20）和对照组（n=20）。咪唑安定组蛛网膜下腔注入0．5％重比重布比卡因2．5ml加咪唑安定1mg（0．2m1），对照组注入0．5％重比重布比卡因2．5ml加生理盐水0．2ml。观察运动神经阻滞（改良Bromage）、感觉神经阻滞（针刺法）、镇痛时间（VAS）、术者和患者对麻醉的满意率。结果咪唑安定组感觉和运动神经阻滞时间显著延长（P〈0．01），术者和患者对麻醉的满意率提高（P〈0．05）。咪唑安定组有效镇痛时间也显著延长（P〈0．001）。两组血流动力学、不良反应情况差别无显著性。结论咪哗安定加入布比卡因能显著延长麻醉作用时间，麻醉效应增强，而不良反应未见增加。     

咪唑安定、异丙酚对体外循环期酸碱平衡的影响

目的 观察异丙酚和咪唑安定在体外循环麻醉中对术前和术中的酸碱度的影响.方法 40例先天性心脏病患者随机分为两组(异丙酚组、咪唑安定组),监测手术前、主动脉阻断10 min和复温至31℃时血气指标等的动态变化.结果与手术前比,主动脉阻断10 min和复温后,血液pH、PaCO2、HCO3-、BEB两组均有明显变化(P＜0.05),但两组间差异无显著性(P＞0.05).结论异丙酚和咪唑安定在体外循环麻醉中其对酸碱度无明显的影响.     

Intrathecal midazolam reduces isoflurane MAC and increases the apnoeic threshold in rats

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - The purpose of this study was to examine the anaesthetic requirement of intrathecal midazolam in a dose-response fashion in...     

异丙酚、咪唑安定、依托咪酯及同芬太尼复合后对大鼠心肌细胞钙离子移动的影响

的　观察麻醉诱导峰浓度的异丙酚、咪唑安定、依托咪酯及同芬太尼复合后,对心肌细胞钙离子移动的影响,研究其对心肌收缩力的作用。方法　用Fluo-3AM钙荧光指示剂染色急性分离的大鼠心肌细胞,在激光共聚焦显微镜下动态观察用药前和使用异丙酚(50μmol/L)、咪唑安定(3μmol/L)、依托咪酯(3μmol/L)及复合芬太尼(20ng/ml)后,KCl诱发的细胞内钙离子荧光强度的变化。结果　异丙酚明显抑制钙离子跨膜内流,细胞内钙荧光强度峰值较对照组下降15.3%(P<0.05),而咪唑安定、依托咪酯虽减慢钙的内流,但最终细胞内钙荧光强度与对照组无统计学差异(P>0.05)。复合芬太尼后,各组细胞内钙荧光强度升高的速度和峰值较单独使用该静脉麻醉药无统计学差异(P>0.05)。结论　复合使用芬太尼不会加重异丙酚、咪唑安定、依托咪酯对心肌细胞钙内流的抑制作用     

Ketamine for analgosedative therapy in intensive care treatment of head-injured patients

Summary Ketamine was supposed to be contra-indicated in head injured patients although it possesses numerous advantages over other commonly used analgosedative drugs. Referring to these potential advantages and the lack of definitive data about its effect upon ICP, CPP or neurological development, we conducted a prospective study in which moderate or severely head injured patients (n=35) were prospectively allocated to receive treatment either with a combination of ketamine and midazolam or fentanyl and midazolam. The initial dose was 6.5 mg/kg/day midazolam, 65 mg/kg/day ketamine or 65 g/kg/day fentanyl and was later adjusted due to clinical requirements for a period of 3 to 14 days. Comparably high dosages of detamine have been found necessary (104 mg/kg/day).Four patients from the ketamine group (n=17) and 5 from the control group (n=18) were withdrawn during treatment due to persistent ICP above 25 mm Hg, countermeasured by barbiturate coma. Two more patients were withdrawn due to development of cardiovascular arrest (ketamine group) and multi organ failure. A comparison of the remaining patients revealed a lower requirement of catecholamines (significant on first day, p<0.05), an on average 8 mm Hg higher cerebral perfusion pressure and a 2 mm Hg higher intracranial pressure in the fentanyl group. Enterai food intake was better in the study group. The outcome was comparable in both groups with or without inclusion of withdrawn patients.     

Dexmedetomidine synergism with midazolam in the elevated plus-maze test in rats

The anxiolytic profile of dexmedetomidine, a novel, highly-selective ₂-adrenergic agonist, was examined in rats in the elevated plus-maze test when administered either alone or in combination with the benzodiazepine agonist midazolam. Dexmedetomidine, 0.1–10 µg/kg, was inactive in modifying the rats' behavioral response in this test. Midazolam, 0.1–10 mg/kg, dose-dependently produced an anxiolytic-like profile characterized by an increased time spent in the open arms of the elevated plus-maze. A combination of dexmedetomidine 0.5 µg/kg and midazolam 0.5 mg/kg produced a synergistic interaction. This heterergic interaction of dexmedetomidine on midazolam's anxiolytic-like profile was dose-dependently blocked by pretreatment with an ₂-adrenergic antagonist, atipamezole, 10–50 µg/kg, and a benzodiazepine antagonist flumazenil, 1.0 and 10 mg/kg, but not by the ₁-adrenergic antagonist, prazosin, 0.1–10 mg/kg. While the transmembrane signal transduction pathways for benzodiazepine- and ₂-agonist responses do not share any molecular component, there does appear to be crosstalk between these two systems. These may involve GABA or noradrenergic downstream effects of either dexmedetomidine or midazolam, respectively.     

高效液相色谱—电喷雾质谱法同时测定人血浆中咖啡因、咪哒唑仑和代谢产物及其在药物代谢研究中的应用

目的:建立高效液相色谱-电喷雾质谱法同时测定人体血浆中咖啡因及代谢物1,7-二甲基黄嘌呤、咪哒唑仑及代谢产物1-羟咪哒唑仑。并将它应用于中药止咳橘红颗粒对CYP3A4和CYP1A2抑制作用的研究。方法:血浆样品先经液-液萃取纯化浓缩后,以ODS-C18为固定相,甲醇-0.01％甲酸不同比例为梯度洗脱流动相,内标物为阿普唑仑。经HPLC分离后的化合物在电喷雾离子源中被电离,电离后以选择离子方式检测各化合物的分子离子峰,以峰的保留时间及质荷比进行定性,以峰面积进行定量。结果:咖啡因、1,7-二甲基黄嘌呤、咪哒唑仑、1-羟咪哒唑仑分别在50～5000 ng·mL-1(r=0.9971),22.4～2240 ng·mL-1(r=0.9982),1.23～123 ng·mL-1(r=0.9997),0.84～84 ng·mL-1(r=0.9983)的范围内呈良好的线性关系。4种化合物的平均回收率均大于90％,日内及日间RSD均小于10％。结论:此方法简便,快速,灵敏,可同时测定人体血浆中咖啡因、咪哒唑仑及各自的主要代谢产物。