A Bioassay of a Water-soluble Benzodiazepine Against Sodium Thiopental

Sarnquist, Frank H.; Mathers, William D.; Brock-Utne, John; Carr, B. I.; Canup, Carol A.; Brown, Colin R.

doi:10.1097/00000542-198002000-00009

Cited by 28 publications

(2 citation statements)

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“…The wide range of times recorded for spontaneous closure of the eyes, failure to respond to command and loss of the palpebral reflex illustrates the variability of the response of patients to benzodiazepines and may also be partly attributable to the low dose used. 4 - 6 Our results support the view 4 ,7,8 that midazolam has only a mild respiratory depressant effect. No patient required assisted ventilation during the procedure.…”

Section: Discussionsupporting

confidence: 83%

Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial

Baber

Hobbes

Munro

et al. 1982

Anaesth Intensive Care

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The peripheral and central nervous, cardiovascular and respiratory effects of midazolam 0.15 mglkg, administered intravenously, were studied in 57 patients. Midazolam induced anaesthesia satisfactorily in 78% of the patients, the remainder required either further doses of midazolam, or alternative induction agents. There was no pain on injection. No evidence of thrombophlebitis was apparent up to 72 hours after injection. Mean systolic arterial pressure decreased from 128 mm Hg to 114 mm Hg and mean diastolic pressure decreased from 75 mm Hg to 67 mm Hg (P < 0.005) four minutes after injection. Mean heart rate increased from 81 beatslmin to 88 beatslmin (P < 0.005) one minute after injection. Apnoea occurred in 14 patients, with a mean onset time of 82 sec and a mean duration of 30 sec. Patients showed a decrease in mean respiratory rate from 13.7 breathslmin to 12.8 breathslmin two minutes after injection of midazolam. A larger dose than used in this study would be necessary for satisfactory use of midazolam as an induction agent for general anaesthesia.

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Section: Discussionsupporting

confidence: 83%

Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial

Baber

Hobbes

Munro

et al. 1982

Anaesth Intensive Care

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“…1,2 An effective premedicant minimizes the emotional trauma in surgical children and may facilitate a smoother induction with minimal haemodynamic alterations. 3 As children exhibit an exaggerated psychological response to a needle, oral route is preferable for premedication in children.…”

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confidence: 99%

Injectable Midazolam as Oral Premedicant in Pediatric Neurosurgery

Mishra

Sinha²,

Rao³

et al. 2005

Journal of Neurosurgical Anesthesiology

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In a randomized, double blind, placebo controlled study; the acceptability, efficacy and safety of injectable midazolam as oral premedicant in children was evaluated. One hundred children (ASA 1,2) aged 6 months to 6 years, undergoing elective neurosurgical operations, like meningomyelocele, meningo-encephalocele, ventriculo peritoneal and other shunts and craniotomies for tumour decompression etc., were included in the study. The patients were randomly assigned to one of four groups (A, B, C, D) receiving respectively saline or 0.50, 0.75 and 1.0 mg/kg midazolam in honey, 45 min before separation from parents. All received identical general anesthesia (GA). Age, sex, weight, heart rate, blood pressure, respiratory rate, saturation (SaO2), reaction to parent's separation, sedation score and duration of anesthesia, recovery conditions and side effects were noted. We found no difference in age, sex, weight, patient acceptability vomiting after ingestion and duration of anesthesia between groups. Even though many children resisted the placement of premedicant in the mouth, only three children spat it out and none vomited after swallowing. The reaction to separation from parents was better after midazolam premedication. However, on reaching the operating room, 24% children (placebo-60%) were found anxious after 0.50 mg/kg, but 12% were deeply sedated after a dose of 1.0 mg/kg. Recovery was similar in groups A, B and C except that more (48%) patients were anxious in group A. Recovery, however was delayed in 16% patients of group D. Though, fewer complications were reported during recovery after midazolam than placebo premedication, they were minimal in the 0.75 mg/kg group. We concluded that giving injectable midazolam orally as premedication in pediatric age group scheduled for neurosurgical operations is acceptable, effective and safe in 0.75 mg/kg dose. While 0.50 mg/kg is less effective, 1.0 mg/kg does not offer any additional benefit over 0.75 mg/kg but does delay recovery and may compromise safety.

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Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Kanto

1985

Pharmacotherapy

180

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Midazolam is a 1,4-benzodiazepine derivative with a unique chemical structure: depending on environmental pH, the drug can produce highly water-soluble salts (pH less than 4) or exist in lipophilic diazepine ring-closed form (pH greater than 4). This characteristic contributes to rapid onset of action and to good local tolerance after parenteral administration. After both oral and parenteral administration, midazolam has a fast absorption rate and is rapidly excreted, with a half-life of only about 2 hours. A reasonably good correlation has been found between plasma levels and clinical effects, indicating a fast but brief response. As a hypnotic, midazolam is mainly indicated in insomniac patients with difficulties in falling asleep or having a pathologic sleep pattern during the first half of the night. No marked hangover effects are present the next morning. In anesthesiology, midazolam appears to be a useful, short-acting, sedative-anxiolytic and amnesic premedicant after both oral and parenteral administration. In minor surgery, however, the slow, unpredictable onset and variable duration of action, as compared with thiopental, may inhibit its routine use as an induction agent, especially in young patients, without heavy premedication. In major surgery, midazolam is an alternative to thiopental for induction of anesthesia in spite of its slow, variable induction time. Its advantages include good cardiovascular stability, transient and mild respiratory depression, low frequency of venous irritation, production of anterograde amnesia and short duration of action in comparison with other benzodiazepines.

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A Bioassay of a Water-soluble Benzodiazepine Against Sodium Thiopental

Cited by 28 publications

References 0 publications

Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial

Midazolam as an Intravenous Induction Agent for General Anaesthesia: A Clinical Trial

Injectable Midazolam as Oral Premedicant in Pediatric Neurosurgery

Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

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