An open randomised, comparative study was planned to evaluate efficacy and tolerability of intramuscular midazolam and oral diazepam for preoperative sedation of patients under anaesthesia. 113 patients [diazepam=57;midazolam=56] of ASA grade 1·11; between 18-60 years of age of either sex participated. Greater anxiety relief (p < 0.0001) was observed in the midazolam group compared to the diazepam group. Midazolam produced better clinically acceptable sedation of short duration. Excellent anterograde amnesia was seen with midazolam with lack of recall of intraoperative events during surgery. Cardiovascular stability was seen with both the drugs. Global quality of premedication assessed by the anaesthesiologist was excellent or good with midazolam as compared to satisfactory or poor with diazepam. MJAFI 2000; 56: 287-292

A single blind parallel group study was performed in 137 patients undergoing elective surgery under general anaesthesia to compare the efficacy and tolerability of midazolam 0.15 to 0.25 mglkg or thiopentone 6 mglkg. Induction time was 45.0±17.1 sees in midazolam group in comparison to 32.0±9.5 sees in thiopentone group and the frequency of apnoea was 11.5% and 17.1% respectively. There was no difference in the duration of apnoea in the two groups. No venous intolerance was experienced during the study. It appears that midazolam is a suitable alternative to thiopentone and would be of value where the latter is contraindicated.MJAFI 2001; 57: 213-214

Rocuronium bromide (2xED), a new non depolarising neuromuscular blocking drug with rapid onset, intermediate duration of action and cardiostability was studied in open randomised trial in 30 patients. Neuromuscular block was monitored using a Train of Four stimulus by stimulator electrodes placed on the ulnar never close to the wrist. Intubation conditions were assessed subjectively by scoring the jaw relaxation, vocal cord and the response to intubation with same technique of anaesthesia. Clinical recovery (Dur) of neuromuscular blockade was monitored. Haemodynamic changes were recorded. Intubation conditions were clinically acceptable in 99.6% of patients, (excellent 73%; good 26.6%) at 90s. Time to onset (Lag time) of neuromuscular block was 22.5 ± 12.6 sec and average time for the onset of block (maximum effect) was 90.9 ±10.6 sec. The duration of clinical muscular relaxation (25% recovery of twitch height) was 22.4 ± 8.30 min. Stability of cardiocirculatory system was seen.

Midazolam, a new benzodiazepine was compared with diazepam as intraoperative sedative during spinal anaesthesia in a double blind study. Eighty five patients participated in this clinical trial (placebo 25, midazolam 30, diazepam 30). Drug treatment was administered after spinal anaesthesia at 5 min of supine position. Level of spinal anaesthesia in terms of sympathetic blocade was similar in aU the patients. Dosage of drug were tailored to the needs of each patient till the end point of undisturbed sleep. Intraoperative sedation based on predetermined criteria, recovery by Trieger's test at 4 hr after the drug administration, antegrade amnesia by memory card and haemodynamics were assessed. Mean doses of 240 Ilg kg-! and 500 Ilg kg-Iof midazolam and diazepam were required to induce sleep which suggest an equivalent dose ratio of midazolam: diazepam as 1: 2.1. Both the drugs produced effective sedation during spinal anaesthesia, 86.6% patient with midazolam and 93.3% patients with diazepam had deep undisturbed sleep. Clinical recovery was fast in midazolam administered patients but did not meet the criteria of early discharge by Trieger's test at 4 hr after the administration of the drug. There were no gross changes in the circulatory effects of the two drugs. Decrease in mean systolic pressure (<10%) and marginal increase in heart rate was seen. The frequency of antegrade amnesia was greater with midazolam. Global assessment as judged by anaesthesiologist and patients satisfaction for anaesthesia and recovery was higher (93.3%) with midazolam as compared to (79.9%) diazepam. Trieger test consists of a series of dots arranged in a simple pattern which the patient connects as accurately as possible. The accuracy and timings were compared with the baseline test carried out before premedication. Decrease in accuracy was measured by recording the number of dots missed and the cumulative distance of miss in mm, compared with the baseline test. Position of the patient, moderator staff, place, material and light were the same during performance of the test.Patients were premedicated with injection atropine 0.6 mg and injection fortwin 0.5 mg kg -I intramuscularly one hour prior to surgery in the anaesthetic room and iv cannula was placed on the dorsum of the hand; heart rate, arterial pressure, level of sedation were recorded.Lumbar puncture was performed in the sitting position at the 3rd interspace and 0.5% plain bupivacaine 4 ml was injected at 1 mi. 5 Sec -I. The patients were returned to the supine position, heart rate, blood pressure and upper level of block (pinprick test of analgesia) were recorded every 5 min until spread ceased. Respiratory rate was also recorded. Drug (placebo, midazolam and diaze-

One hundred and forty ASA physical status I and II patients undergoing general or gynaecological surgery were the subjects of this study. Patients were randomly assigned into five groups receiving 100, 150, 180, 200 and 250~gIkg lV. of chandonium iodide after induction of general anaesthesia with thiopentone. Neuromuscular blockade was assessed clinically, as well as, with twitch response/train of four using myotest nerve stimulator. Increasing dosage of chandonium iodide decreased the time to onset of jaw relaxation and apnoea (p