Purpose: Propofol is often used for sedation during spinal anesthesia. We investigated the effects of midazolam premedication on the propofol requirements and incidence of complications during sedation. Methods:In a prospective randomized, controlled, and single-blinded study, 50 patients undergoing elective gynecological surgery were randomly divided into control and midazolam groups. Patients in the midazolam group received 2 mg midazolam im 30 min before arrival at the operation room. After spinal anesthesia was instituted with intrathecal injection of hyperbaric tetracaine, we provided sedation using continuous infusion of propofol. The level of sedation was controlled at a level between "eyes closed but rousable to command" and "eyes closed but rousable to mild physical stimulation" by adjusting the infusion rate. During sedation, the propofol requirements and complications were recorded and patients were asked, two hours after the end of operation, whether they remembered intraoperative events.Results: In the midazolam group, the loading dose, steady state infusion rate, and overall infusion rate of propofol were 0.74 mg·kg -1 , 2.86 mg·kg -1 ·hr -1 , and 3.32 mg·kg -1 ·hr -1 , respectively, which were about 17% lower than those in the control group (P < 0.05). Moreover, midazolam premedication reduced the incidence of intraoperative memory (P < 0.05), but had no effects on other complications. Conclusion:Midazolam premedication reduced propofol requirements and the incidence of intraoperative memory during sedation. These effects on sedation using propofol during spinal anesthesia are considered beneficial for patients. ObjectifObjectif :: Le propofol est souvent utilisé pour la sédation pendant la rachianesthésie. Nous avons exploré les effets de la prémédication avec du midazolam sur les besoins en propofol et sur l'incidence de complications pendant la sédation. Méthode Méthode :: Lors d'une étude prospective, randomisée, contrôlée et à simple insu, 50 patientes pour qui une intervention gynécologique avait été prévue ont été réparties de façon aléatoire en un groupe témoin et un groupe midazolam. Les patientes du groupe midazolam ont reçu 2 mg de midazolam im, 30 min avant l'arrivée en salle d'opération. Après la mise en route de la rachianesthésie avec une injection intrathécale de tétracaïne hyperbare, nous avons administré la sédation par une perfusion continue de propofol. La sédation a été contrôlée à un niveau se situant entre le moment où les patientes ont «les yeux fermés mais peuvent être éveillées sur commande» et le moment où elles ont «les yeux fermés mais peuvent être éveillées sous une légère stimulation physique», en ajustant la vitesse de perfusion. Pendant la sédation, les besoins de propofol et les complications ont été notés et on a demandé aux patientes, deux heures avant la fin de l'opération, si elles se rappelaient des événements peropératoires.Résultats : Dans le groupe midazolam, la dose de charge, la vitesse de perfusion à l'état d'équilibre et la vitesse globale de perfusion...

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Toborinone ((+/-)-6-[3-(3,4-dimethoxybenzylamino)-2-hydroxypropoxy]-2(1H)-qui nolinone, CAS 128667-95-8, OPC-18790), a novel cardiotonic agent with an inhibitory action on phosphodiesterase, is known to have a potent positive inotropic action with no positive chronotropic effect. The effectiveness of this drug in the treatment of heart failure occurring immediately after extracorporeal circulation (ECC) in cardiac surgery was investigated. The study was conducted in 12 patients with valvular heart disease showing a cardiac index (CI) of below 2.8 l/min/m2 and/or pulmonary capillary wedge pressure (PCWP) or pulmonary arterial diastolic pressure (PAD) of above 8 mmHg immediately after extracorporeal circulation. In group A (n = 6), toborinone was infused at a rate of 40 micrograms/kg/min for the first 5 min and then at 10 micrograms/kg/min for 85 min. In group B (n = 6), the drug was infused at a rate of 10 micrograms/kg/min for the entire 90 min. CI, mean systemic arterial pressure (mSAP), mean pulmonary artery pressure (mPAP), CVP, PCWP, and heart rate were measured at 5, 15, 30, 60, and 90 min after the start of infusion. The infusion volume required to maintain a constant PCWP was also estimated. In group A, CI increased rapidly and significantly from the baseline of 2.48 +/- 0.23 l/min/m2 to 3.57 +/- 1.07 l/min/m2 at 5 min after the start of infusion, and at that time mSAP was slightly decreased. In group B, CI increased gradually from the baseline of 2.53 +/- 0.18 l/min/m2 to 3.08 +/- 0.34 l/min/m2 at 15 min after the start of infusion, but almost no change was seen in mSAP. During the first 30 min, group A required a significantly larger infusion volume (983 +/- 395 ml) than group B (475 +/- 184 ml). From 30 to 90 min after the start of infusion, CI remained increased to similar levels in both groups and mSAP levels were also similar. There were no significant differences between the two groups in any other parameter. Continuous infusion of toborinone appears to be effective for treating heart failure occurring immediately after ECC in cardiac surgery. Initial loading at a rate of 40 micrograms/kg/min rapidly increased CI but was accompanied by mild hypotension. Constant infusion at 10 micrograms/kg/min brought about a more gradual effect that was similar to that of loading at 40 micrograms/kg/min, but without inducing hypotension. Thus, infusion at 10 micrograms/kg/min is considered preferable in order to avoid a larger-than-necessary infusion volume.

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