Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support
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To evaluate the efficacy of continuous infusions of lorazepam vs. midazolam for sedation in the intensive care unit (ICU). Design: Prospective, randomized study. Setting: Large, urban university hospital. Patients: Twenty adult medical ICU patients receiving mechanical ventilatory support. Interventions: Patients were randomized to receive either lorazepam or midazolam. The infusion rate was adjusted at the bedside by the ICU nurse according to a standardized study protocol to achieve and maintain sedation at Ramsay's sedation level 2 or 3. Measurements and Main Results: Ten patients were randomized to receive lorazepam and ten to receive midazolam. The groups were similar in demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, ICU admission diagnosis, underlying disease processes, and supplemental analgesic administration. The mean time to achieve initial adequate sedation was 124 mins for lorazepam and 105 mins for midazolam. The mean infusion rate at the point of initial sedation was 0.06 mg/kg/hr for lorazepam and 0.15 mg/kg/hr for midazolam. The maximum and mean infusion rates for the entire study period were 0.1 and 0.06 mg/kg/hr, respectively, for lorazepam and 0.29 and 0.24 mg/kg/hr, respectively, for midazolam. The number of infusion rate adjustments per day was 1.9 mg/kg/hr for lorazepam and 3.6 mg/kg/hr for midazolam. Of the surviving patients, the mean time to return to baseline mental status after discontinuation of the benzodiazepine infusion was 261 mins for lorazepam and 1815 mins for midazolam. The mean volume of fluid per day required to deliver the maximum dose of benzodiazepine was 1.2 L for lorazepam (maximum 2.4 L) and 1.3 L for midazolam (maximum 3.6 L). Conclusions: While there was a tendency to a longer time required for return to baseline mental status in patients receiving midazolam, this was not statistically signficant. Findings of interest concerning both midazolam and lorazepam were: a) time to achieve sedation in medical ICU patients is often prolonged; b) actual dose requirements necessary to maintain sedation in this patient population are larger than the current literature describes; c) time to awaken after discontinuation of the infusion was occasionally delayed for >24 hrs; d) large volumes of fluid were required to deliver these doses of drug via this route of administration. (Crit Care Med 1994; 22:1241–1247)Keywords:
Midazolam
Lorazepam
Discontinuation
Objective To investigate applicability and effect of midazolam and propofol on sedative of patients with mechanical ventilation in ICU.Methods 96 cases of patients with sedative treatment were selected and randomly divided into midazolam groups and propofol groups,effect of sedative,onset time and awakening time were contrasted between midazolam groups and propofol groups.Results maintenance dosage was lower in midazolam groups than in propofol groups(P0.05),adjust number of medicine was identical between midazolam groups and propofol groups,onset time and awakening time were longer in midazolam groups than in propofol groups(P0.05).Conclusions propofol was suitable to applied in short term sedative and midazolam was suitable to applied in long-playing sedative,and should be discriminate in sedative treatment on patients in ICU.
Midazolam
Artificial ventilation
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Background: An efficacious, reliable, and non-invasive route of administration for midazolam, a drug used for sedation and pre-anesthetic medication, would have obvious advantages. This study compares the sedation achieved by nebulized route and intravenous route as procedural sedation.Methods: A randomized double-blinded interventional study was designed to compare the effect of nebulized midazolam with intravenous midazolam as a sedative medication in 86 children undergoing imaging procedures like CT scan, MRI scan, EEG. Ramsay sedation scores and parameters of cardiovascular and respiratory function were measured over 20 min and summarized Results: The mean sedation score in both groups was comparable at baseline, 10 minutes and 20 minutes with p values of 0.1, 0.1, 0.09 respectively. Parameters of cardiovascular and respiratory function were comparable in both the groups. Conclusion: Present study showed that nebulized midazolam when given at a higher dose of 1 mg/kg was found to be as potent as intravenous midazolam, opening up a door for a sedative which is easier to administer, has better acceptance with lesser complication.
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Objective To study the anterograde amnesia caused by midazolam which was used by patient-controlled sedation and anesthetist-controlled sedation.Methods 120 patients in surgical patients were divided ran-domly into two groups,60 patients in each.P group:patient-controlled sedation with midazolam;A group:anesthetist-controlled sedation with midazolam.Atropine 0.5mg was injected 30rain before operation,explaining the correct appli-cation of PCA pump to patients when we interview them.HR,ECG,BP,SPO2 were monitored during anesthesia.P group:midazolam 20mg+normal saline(NS) to 100mL,midazolam loding dose 0.02mg.kg-1,continous rates 0.001mg.kg-1.h-1,PCS 0.02mg.kg-1,lockout time 3min,PCS rates 30 seconds.A group:midazolam loding dose 0.02 mL.kg-1,continue rate 0.001mg.kg-1.h-1,Ramsay sedation score was used to evaluate the sedative depth every 10 minutes,appropriate sedative depth(Ramsay sedation score 4) kept by adjusting the infusion rate.Showing patients three pictures before sedation started,and checking patient memory at 12h after operation.Accessing the patient’s satisfaction degree by VAS score.Results The amount of midazolam was a little higher in P group(10±4)mg,than that in A group(9±3) mg,but there was no significant difference(P0.05).Postoperative anterograde amnesia existed in both two groups,memorability has no significant difference between two groups(P0.05),and there was a statistic difference between two groups [P group(89 ± 6) and A group(71 ± 8)] in patient satisfaction degree(P0.001).Conclusion Satisfactory anterograde amnesia occurred in both PCS group and ACS group.Patient preferred PCS.
Midazolam
Anterograde amnesia
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Objective
To observe the effects of continuous injection sedation and target controlled infusion(TCI)sedation with midazolam and sulfentanyl for mechanical ventilation of ICU patients.
Methods
62 mechanical ventilation patients were randomly divided into continuous group(n= 31)and TCI group. Continuous group was given sedation with midazolam and sulfentanyl by continuous pumping. Sedation with fentanyl and midazolam pumping was adjusted to keep SAS scores of 3- 4 points and bispectral index(BSI)of 70- 75 in TCI group. The sedation span, sedative consumption and vital signs were measured and recorded.
Results
Compared with continuous group, the consumption of midazolam[(1.29±0.4)mg·kg- 1·24h- 1]and sulfentanyl[(16.9±4.3)μg·kg- 1·24h- 1]in TCI group was significantly lower(t= 2.875,2.593,all P 0.05).Sedation satisfaction degree(62%) and human adaptation degree(87%) in TCI group were significantly higher than continuous group(χ2= 3.883,2.204,all P<0.05).After sedative administration,HR,MAP and Sp O 2 did not significantly decrease compared with baseline.
Conclusion
TCI sedation can significantly decrease sedative administration of midazolam and sulfentanyl and increase human adaptation degree for mechanical ventilation ICU patients. TCI sedation could be a safe and effective sedation administration.
Key words:
Midazolam; Sufentanyl; Hypnotics and Sedatives
Midazolam
Bispectral index
Continuous Infusion
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Crossover study
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Background and objective No consensus exists for the safest and most effective agent and for optimal drug doses for sedation during endoscopic retrograde cholangiopancreatography (ERCP). We aimed to compare the efficacy of midazolam with that of midazolam+meperidine, which provided comfort for the patient during ERCP. Materials and methods The patients were randomized to sedation with midazolam only (2.87±0.67 mg) (n=48, median age 55.54±14.66, 21 women, 27 men) or midazolam (1.82±0.71 mg) with meperidine (42.81±14.61 mg) (n= 48, median age 55.48±2.57, 20 women, 28 men). Procedure-related parameters and the efficacy of sedation as assessed by the endoscopist and the patients were compared. Results Prior endoscopic history, preprocedure anxiety scores, age, sex, baseline vital signs and type of interventions were similar in both groups. Sedation level, duration of procedure and recovery time were comparable in both groups. Sedation quality assessment scale was significantly higher in the midazolam with meperidine group. Degree of pain sensed during the procedure was significantly lower in the midazolam with meperidine group. Midazolam with meperidine group had better patient satisfaction. Twenty-four hours after the procedure, the degree of amnesia between both sedation groups was similar. The number of patients unwilling to repeat the procedure was distinctly higher in midazolam group. Development of hypoxia and arrythmia in the midazolam and midazolam with meperidine groups were comparable. Two patients in the midazolam group developed paradoxical agitation. Conclusions Conscious sedation for ERCP can be successfully and safely achieved by using either only midazolam or a low dose of midazolam with meperidine. Adding of meperidine to midazolam resulted in better patient and endoscopist comfort.
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Pethidine
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We studied midazolam plasma concentrations in patients undergoing middle ear surgery (MES) in local anesthesia and sedation. This study was based on the clinical measurement of the level of sedation and determination of the sedation dose of midazolam. For optimal level of sedation for this type of surgery we suggest the midazolam plasma concentrations with median of 0.03 mg L-1 and range from 0.01-0.10 mg L-1. This can be contrasted to the other studies where considerably higher plasma concentrations of midazolam (0.2 mg L-1) were proposed (S. Michalk et al., Intens. Care Med. 1988, 15, 37-41). Despite low midazolam concentrations the level of sedation was adequate.
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Purpose: The primary aim of this study was to evaluate whether differences exist in patient satisfaction between groups receiving fentanyl/midazolam and those receiving meperidine/midazolam for general endoscopy conscious sedation. Methods: In this prospective study, answers to the 20 question Patient Satisfaction with Sedation Instrument (PSSI) were collected from 198 patients who received either fentanyl/midazolam (N=91) or meperidine/midazolam (N=107) during endoscopy. The total score, sedation delivery subscale score, procedure recall subscale score, sedation side effects subscale score, and global satisfaction subscale score were calculated according to the PSSI guidelines, where higher scores indicate increased satisfaction. Patient characteristics and endoscopy information were compared between fentanyl/midazolam and meperidine/midazolam groups using Fisher's exact test or a Wilcoxon rank sum test. Results: The distribution of patient age, gender, and interventions were relatively similar between fentanyl/midazolam and meperidine/midazolam groups. There were two significant differences in PSSI responses between the two groups. Patients in the meperidine/midazolam group were more often “very satisfied” with the length of time they felt the effects of the sedation (77% vs. 65%, P=0.048). Also, patients in the meperidine/midazolam group responded “very satisfied” more often regarding how they would compare their satisfaction with this experience to their previous experience with endoscopy (86% vs. 71%, P=0.014). In the PSSI subscale scores between the two sedation groups, results were similar except for the sedation delivery subscale score, which was significantly higher in meperidine/midazolam patients compared to fentanyl/midazolam patients (P=0.034). The sedation delivery subscale score incorporated several questions including ease of medication administration and pain associated with delivery. Conclusion: In this prospective study, we utilized the PSSI, which has previously been externally validated, to compare patient satisfaction with sedation between two groups who received commonly administered regimens. We observed that patients were overall satisfied with sedation in both groups. However, there were several questions for which patients who received meperidine/midazolam were more satisfied than patients who received fentanyl/midazolam, where differences either reached statistical significance or trended toward significance.
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