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January 1998
Midazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization.
Richardson MG, Wu CL, Hussain A;
Anesth Analg 1997;85:301-5.
[ see abstract below ]
It is not known whether residual midazolam effects in the immediate postoperative period may contribute to postoperative sedation and delayed discharge. These authors examined patients having laparoscopic tubal sterilization by Falope rings, because postoperative opioids are frequently needed, and this might exacerbate the possible sedation.
The study group consisted of 30 women with ages 31-36 years, weight 66 kg, surgery time 27-28 minutes and anesthesia time 46 minutes. [The sample size of 30 patients total was determined by a power analysis based on a 20 minute difference in PACU I discharge time.] Anesthesia was induced with fentanyl 1.5 ug/kg, propofol, mivacurium, 70% nitrous oxide, isoflurane and ketorolac. In the PACU, patients received morphine 2 mg IV as needed for analgesia. The average doses of morphine given were 9 and 10 mg in the 2 groups.
The authors found that there were no differences in PACU recovery time (55-57 minutes) or ambulatory surgery care unit recovery times (188-180 minutes), for a total recovery time in the facility of approximately 4 hours. Neither pain nor nausea VAS scores were different at any time point. The patients who received midazolam premedication showed significant decrements in digit substitution test scores at 5-30 minutes in PACU and in Trieger dot deviation scores at 15 minutes in PACU.
The authors found that for patients who received both intraoperative fentanyl and postoperative morphine for brief painful outpatient procedures, midazolam premedication did not delay discharge at 4 hours.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Preoperatively administered midazolam may contribute to postoperative sedation and delayed recovery from brief outpatient general anesthesia, particularly in patients who receive significant postoperative opioid analgesics.
We evaluated the effects of midazolam premedication (0.04 mg/kg) on postoperative sedation and recovery times after laparoscopic tubal sterilization (Falope rings) in 30 healthy women in a randomized, double-blind, placebo-controlled study. Patients received midazolam or saline-placebo intravenously 10 min before anesthesia. General anesthesia was induced with fentanyl, propofol, and mivacurium and was maintained with N2O and isoflurane.
Sedation was quantified before and after premedication and 15, 30, and 60 min after emergence from anesthesia, using the digit-symbol substitution (DSST) and Trieger dot (TDT) tests. Management of postoperative pain and nausea and discharge criteria were standardized. Groups were similar with respect to age, weight, and duration of surgery and anesthesia.
Midazolam was associated with impairment of performance on the TDT and DSST after premedication administration and 15 (TDT and DSST) and 30 (DSST) min after postanesthesia care unit (PACU) arrival. There were no differences in PACU time and time to discharge-readiness.
In conclusion, midazolam premedication augments postoperative sedation in this population but does not prolong recovery times.
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