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Comparison of sedative effectiveness of thiopental versus Midazolam in reduction of shoulder dislocation

World Journal of Emergency Medicine 2018年第2期9卷 125-129页

作者： Elnaz Vahidi Rezvan Hemati Mehdi Momeni Amirhossein Jahanshir Morteza Saeedi Emergency Medicine Research Center Shariati Hospital Emergency Medicine Department Tehran University of Medical Sciences

BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus Midazolam in reduction of shoulder dislocation.METHODS: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 μg/kg fentanyl while control group received intravenous Midazolam 0.1 mg/kg+2 μg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all recorded.RESULTS: Muscular tone had significant difference between the two groups(P-value=0.014) and thiopental was more muscle relaxant than Midazolam. Replacement of shoulder dislocation in thiopental group was easier than Midazolam group(P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the Midazolam group(A) and 8.94±1.78 in the thiopental group(B); mean difference 0.57, 95% CI= –0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group(A) and(B) were 3.20±1.30 vs. 3.65±1.30; mean difference –0.45, 95% CI= –1.07 to 0.16.CONCLUSION: Thiopental might be more effective and relaxant than Midazolam for reduction of shoulder dislocation.

关键词： Thiopental Shoulder dislocation Midazolam Emergency medicine

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Dexmedetomidine-Midazolam versus Sufentanil-Midazolam for Awake Fiberoptic Nasotracheal Intubation： A Randomized Double-blind Study

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Chinese Medical Journal 2015年第23期128卷 3143-3148页

作者： Cheng-Wen Li Yan-Dong Li Hai-Tao Tian Xian-Gang Kong Kui Chen Department of Anesthesiology Jining No. 1 People's Hospital Jining Shandong 272011 China Department of Anesthesiology Affiliated Hospital of Jining Medical University Jining Shandong 272029 Chin

Background： Awake fiberoptic intubation （AFOI） is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with Midazolam （DM） and sufentanil with Midazolam （SM） for sedation for awake fiberoptic nasotracheal intubation. Methods： Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups （n = 25 per group） by a computer-generated randomization schedule. All subjects received Midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified ＂spray-as-you-go＂ technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infllsion of 0.25 μg.kg^-1.h ^-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 rain followed by a continuous infusion of 0.1 μg.kg^-1.h ^-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose ofMidazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers＇Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed.Results： The scores of ease of the AFOI procedure, patient＇s reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups （z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P 〉 0.05）. Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO, after intubation was higher in Group SM than that in Group DM （45.2 ± 4.2 mmHg vs. 42.2 ±4.3 mmHg, t = 2.495, P 〈 0.05）. Conclusions： Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with Midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.

关键词： Awake Fiberoptic lntubation： Conscious Sedation： Dexmedetomidine Midazolam Sufentanil

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How to improve patient satisfaction during Midazolam sedation for gastrointestinal endoscopy?

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World Journal of Gastroenterology 2017年第6期23卷 1098-1105页

作者： Eun Hyo Jin Kyoung Sup Hong Young Lee Ji Yeon Seo Ji Min Choi Jaeyoung Chun Sang Gyun Kim Joo Sung Kim Hyun Chae Jung Department of Internal Medicine Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam Center Department of Internal Medicine Liver Research InstituteSeoul National University College of Medicine Department of Biostatistics and Bioinformatics Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam Center

AIM To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODS We prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with Midazolam sedation between March 2014 and August 2014. All patients completed both pre- and postendoscopy questionnaires about sedation expectations and satisfaction. RESULTS The study cohort included 167 (36.6%) patients whounderwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122(26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using Midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer interprocedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group. CONCLUSION Midazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age(≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

关键词：有意识的镇静耐心的满足内视镜检查法 Midazolam 调查和问询表

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Effect of Midazolam on the proliferation of neural stem cells isolated from rat hippocampus

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Neural Regeneration Research 2012年第19期7卷 1475-1482页

作者： Sanjun Zhao Yajing Zhu Rui Xue Yunfeng Li Hui Lu Weidong Mi Department of Anesthesiology the General Hospital of Chinese PLA Beijing 100853 China Department of Obstetrics and Gynecology Luhe Teaching Hospital Capital Medical University Beijing 101100 China Beijing Institute of Pharmacology and Toxicology Beijing 100853 China The 254 Hospital of Chinese PLA Tianjin 300142 China

In many recent studies, the inhibitory transmitter gamma-aminobutyric acid has been shown to modulate the proliferation, differentiation and survival of neural stem cells. Most general anesthetics are partial or allosteric gamma-aminobutyric acid A receptor agonists, suggesting that general anesthetics could alter the behavior of neural stem cells. The neuroprotective efficacy of general anesthetics has been recognized for decades, but their effects on the proliferation of neural stem cells have received little attention. This study investigated the potential effect of Midazolam, an extensively used general anesthetic and allosteric gamma-aminobutyric acid A receptor agonist, on the proliferation of neural stem cells in vitro and preliminarily explored the underlying mechanism. The proliferation of neural stem cells was tested using both Cell Counting Kit 8 and bromodeoxyuridine incorporation experiments. Cell distribution analysis was performed to describe changes in the cell cycle distribution in response to Midazolam. Calcium imaging was employed to explore the molecular signaling pathways activated by Midazolam. Midazolam （30-90 IJM） decreased the proliferation of neural stem cells in vitro. Pretreatment with the gamma-aminobutyric acid A receptor antagonist bicuculline or Na-K-2CI cotransport inhibitor furosemide partially rescued this inhibition. In addition, Midazolam triggered a calcium influx into neural stem cells. The suppressive effect of Midazolam on the proliferation of neural stem cells can be partly attributed to the activation of gamma-aminobutyric acid A receptor. The calcium influx triggered by Midazolam may be a trigger factor leading to further downstream events.

关键词： general anesthetics gamma-aminobutyric acid A receptor Midazolam hippocampus neural stemcells proliferation nerve injury neural regeneration

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Comparison of impact of adjuvant treatment of Midazolam, fentanyl, and magnesium sulfate with intrathecal bupivacaine on block characteristics and postoperative analgesia in knee arthroplasty: A randomized clinical trial

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Journal of Acute Disease 2022年第3期11卷 94-100页

作者： Hesameddin Modir Esmail Moshiri Mehran Azami Tayebe Sadat Sayafi-Sharifi Anesthesiology Department Arak University of Medical SciencesArakIran Department of Orthopedic Surgery Arak University of Medical SciencesArakIran Student Research Committee Arak University of Medical SciencesArakIran

Objective:To compare the efficacy of Midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists classⅠorⅡ,who needed knee arthroplasty.Patients were stratified into three intervention groups,including the Midazolam group,the fentanyl group,and the magnesium sulfate group,and the patients were administered with Midazolam,fentanyl,and magnesium sulfate,respectively.Hemodynamic parameters,sensory and motor block,and pain score(Visual Analogue Scale)were measured and compared among the three groups.Results:A total of 105 patients were included in this study with 35 patients in each group.There was no statistically significant difference in terms of oxygen saturation,mean blood pressure,duration of surgery,and postoperative complications,including nausea,vomiting,bradycardia,dizziness,and hypotension,as well as the time of opioid administration among the three groups(P>0.05).Statistically significant differences were found in terms of heart rate at 15,30,45,60,75,and 105 min after beginning of operation among the three groups,which was lower in the Midazolam group(PMidazolam group showed a shorter time to achieve sensory block after spinal anesthesia,sensory block to T8 or higher and sensory block to T12 and L1(P0.05).Conclusion:Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher,the onset of motor block and sensory block after spinal anesthesia,and time to achieve sensory block to T12 and L1,and the pain scores were not significantly different among the groups.Thus,midazo

关键词： Block characteristics Bupivacaine Fentanyl Hemodynamic changes Intrathecal Magnesium sulfate Midazolam

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Effect of oral premedication of Midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery: A randomized clinical trial

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Journal of Acute Disease 2022年第4期11卷 133-139页

作者： Aref Zarei Hesameddin Modir Behnam Mahmoodiyeh Alireza Kamali Farzad Zamani-Barsari Student Research Committee Arak University of Medical SciencesArakIran Anesthesiology Department Arak University of Medical SciencesArakIran Department of ENT Surgery Arak University of Medical SciencesArakIran

Objective:To compare effect of Midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,randomized,double-blind,clinical trial focused on a pediatric population aged 2-7 years(n=153)with the American Society of AnesthesiologistsⅠ-Ⅱwho required elective surgery.The patients were stratified into three intervention groups:Midazolam,ketamine,and dexmedetomidine.Hemodynamic parameters(blood pressure,heart rate,and oxygen saturation)every 5 min until induction of anesthesia along with non-hemodynamic factors,comprised of sedation score before the administration and at the time of being separated from the parents,as well as parental separation anxiety scale,acceptance of anesthesia induction,and side effects were recorded and compared.Results:No statistically significant difference in oxygen saturation,heart rate,blood pressure,duration of surgery,time to achieve an Aldrete score of 9-10,or sedation score was noted in the study groups.More patients in the dexmedetomidine and Midazolam groups could better ease parental separation anxiety than the ketamine group(P=0.001).Moreover,fewer patients accept anesthesia induction(P=0.001)and more had side effects in the ketamine group(P=0.047).Conclusions:Our findings indicate that compared to the ketamine group,dexmedetomidine and Midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects.Dexmedetomidine and Midazolam may be considered better choices.However,the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference.Clinical registarion:This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.

关键词： Dexmedetomidine Ketamine Midazolam Premedication Sedation

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Midazolam Impairs Learning and Memory Ability Through ERK/CREB Signaling Pathway and Oxidative Damage of Hippocampus in Rats

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Journal of Northeast Agricultural University(English Edition) 2022年第3期29卷 48-58页

作者： Zhao Ming-chao Ma Tian-wen Song Xiao-peng Zhou Tong Chen Hong Tang Ji-lang Wang Xin-yu Liu Lin Bai Hui Gao Li Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine College of Veterinary MedicineNortheast Agricultural UniversityHarbin 150030China

This study aimed to elucidate whether Midazolam affected the learning and memory of rats through the extracellular signal-regulated kinase(ERK)/cyclic adenosine monophosphate response element-binding(CREB)signaling pathway and hippocampal oxidative damage.Overall 120 Wistar rats were randomly assigned to four groups,including one control and three Midazolam-exposed groups(20,60 and 150 mg•kg^(-1)).After an intraperitoneal injection of Midazolam/physiological saline for both 1 h(n=15)and 24 h(n=15),10 rats(five came from 1 h,and the remaining five came from 24 h)were randomly selected from each group for the Morris water maze test.The hippocampus tissue samples were harvested for the assessment of superoxide dismutase(SOD)and catalase(CAT)activities as well as glutathione peroxidase(GPx),malonyl dialdehyde(MDA),nitric oxide(NO)and inducible nitric oxide synthase(iNOS)levels.The remaining 80 rats were euthanized,and the hippocampal tissue was isolated.The expressions of ERK1,ERK2 and CREB mRNA were tested using RT-qPCR.The protein expressions of p-ERK1/2 and p-CREB were tested using Western blotting.The Morris water maze tests indicated that Midazolam-treated rats have weaker learning and memory ability compared to the control rats.Midazolam increased MDA,NO,iNOS and CAT,and decreased GPx and SOD activities compared to the control group.The expression levels of ERK1/2 and CREB in the hippocampus of rats in the Midazolam treatment groups were significantly lower compared to the control group at 1 h after intraperitoneal injection of Midazolam,and in a dose-dependent relationship but returning it to normal levels at 24 h after Midazolam intraperitoneal injection.Therefore,it was concluded that the learning and memory impairment of Midazolam might be associated with the down-regulation of the ERK/CREB signaling pathway and oxidative damage in rat hippocampus.

关键词： Midazolam learning and memory ERK/CREB oxidative damage hippocampus

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Effects of ketamine and Midazolam on morphology of dendritic spines in hippocampal CA1 region of neonatal mice

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Chinese Medical Journal 2009年第4期122卷 455-459页

作者： TAN Hong REN Rong-rong XIONG Zhi-qi WANG Ying-wei Department of Anesthesiology Xinhua Hospital Shanghai JiaoTong University College of Medicine Shanghai 200092 China Institute of Neuroscience and Key Laboratory of Neurobiology Shanghai Institutes for Biological Sciences Chinese Academy ofSciences Shanghai 200031 China

Background It is a common phenomenon that children experience multiple general anesthesias in clinical practice, which raises the question whether repeated exposure to general anesthetics would interfere with the development of the central nervous system of children. The present study was designed to evaluate the effects of repeated treatment with ketamine or Midazolam on postnatal dendrite development by examining the morphology of the dendritic spines of the pyramidal neurons in the hippocampal CA1 region in mice. Methods The transgenic green fluorescent protein-M line （GFP-M） mice were used in this study. Ketamine （100 mg/kg） Midazolam （50 mg/kg） or saline （10 ml/kg） was administered intraperitoneally once a day on consecutive days from postnatal day 8 （P8） to postnatal day 12 （P12）. At postnatal day 13 （P13） and postnatal day 30 （P30）, the density and length of the apical dendritic spines of the pyramidal neurons in the hippocampal CA1 region were examined under a confocal microscope. Results At P13, for both the ketamine group and the Midazolam group, the dendritic spines were found with a comparatively lower density and longer average length than in the control group. At P30, no significant difference in the density or average length of dendritic spines was found between the anesthetic group and control group. Conclusions This study indicated that repeated exposure to ketamine or Midazolam in neonatal mice impaired dendritic spine maturation immediately afterwards, but this influence seemed to disappear during further postnatal development.

关键词： dendritic spines ketamine Midazolam confocal

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Voltammetric behavior of sedative drug Midazolam at glassy carbon electrode in solubilized systems

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Journal of Pharmaceutical Analysis 2012年第2期2卷 123-129页

作者： Rajeev Jain Rajeev Kumar Yadav School of Studies in Chemistry Jiwaji University

Redox behavior of Midazolam was studied at a glassy carbon electrode in various buffer systems,supporting electrolytes and pH using differential paise,square-wave and cyclic voltammetry.Based on its reduction behavior,a direct differential pulse voltammetric method has been developed and validated for the determination of Midazolam in parenteral dosage.Three welldefined peaks were observed in 0.1％ SLS,Britton-Robinson (BR) buffer of pH 2.5.The effect of surfaetants like sodium lauryl sulfate (SLS),cetyl trimethyl ammonium bromide (CTAB) and Tween 20 was studied.Among these surfactants SLS showed significant enhancement in reduction peak.The cathodic peak currents were directly proportional to the concentration of Midazolam with correlation coetfficient of 0.99.

关键词： Midazolam Voltammetry Surfactant Glassy carbon electrode Parenteral dosage form

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Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy

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World Journal of Clinical Cases 2021年第29期9卷 8763-8772页

作者： Eun Hyo Jin Ji Hyun Song Jooyoung Lee Jung Ho Bae Su Jin Chung Department of Internal Medicine Healthcare Research InstituteHealthcare System Gangnam CenterSeoul National University HospitalSeoul 06236South Korea

BACKGROUND Midazolam is commonly used for sedation during gastrointestinal procedures.However,some patients experience paradoxical reactions characterized by excessive movement or excitement.AIM To investigate the rate of recurrence of paradoxical reactions to Midazolam during an upper endoscopy.METHODS We retrospectively reviewed 122152 sedative endoscopies among a total of 58553 patients at the Seoul National University Hospital,Healthcare System Gangnam Center,from July 2013 to December 2018.Among them,361 patients with a history of paradoxical reaction during sedative upper endoscopy were enrolled.The characteristics of patients in the recurrent and non-recurrent groups were compared via multivariable analysis using logistic regression.RESULTS Paradoxical reactions occurred in 0.86%(1054/122152)of endoscopies,and in 1.51%(888/58553)of patients.Among the 361 subjects with previous paradoxical reactions in sedative endoscopies,111(30.7%)experienced further paradoxical reactions.Univariable analysis revealed that the total Midazolam dose used was higher in the recurrent group(6.74±2.58 mg)than in the non-recurrent group(5.49±2.04 mg;PMidazolam than previous doses:1 mg less in the recurrent group and 2 mg less in the non-recurrent group.Multivariable analysis showed that the Midazolam dose difference was an independent risk factor for recurrent paradoxical reaction(odds ratio:1.213,95%CI:1.099-1.338,P=0.0001).CONCLUSION The rate of recurrence of paradoxical reactions is significantly associated with Midazolam dosage.The dose of Midazolam administered to patients with previous paradoxical reactions should be less than that previously used.

关键词： Gastroscopy Endoscopy Conscious sedation Midazolam Flumazenil

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