The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting

Grant, Michael C.; Kim, Jimin; Page, Andrew J.; Hobson, Deborah B.; Wick, Elizabeth C.; Wu, Christopher L.

doi:10.1213/ane.0000000000000941

Cited by 63 publications

(57 citation statements)

References 24 publications

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“…One week after surgery, the quality of recovery was even higher showing that the patients were recovering from surgery (ERAS protocol) and were almost ready for discharge. Grant et al 12 Ahn et al 13 and Mijderwijk et al 27 described reduced PONV after perioperative administration of midazolam. These effects may improve the quality of recovery.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Moreover, premedication with midazolam lowers the incidence of PONV, which might contribute to a better postoperative experience for patients. 12,13 Nevertheless, whether midazolam improves the overall quality of postoperative recovery is unknown. 14 For example, in two trials, one in ambulatory surgery patients and the other in patients undergoing scheduled inpatient surgery, lorazepam had no beneficial effect on the quality of postoperative recovery and actually resulted in a slower reduction in anxiety and increased aggression after surgery.…”

Section: Résumémentioning

confidence: 99%

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The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Beek¹,

Kroon²,

Rijs³

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Despite the uncertain effects of anxiolytic premedication with benzodiazepines on the quality of postoperative recovery, perioperative benzodiazepine administration is still a common practice in many hospitals. We evaluated the effect of premedication with midazolam on the quality of recovery in hospitalized patients undergoing a laparotomy. Methods We conducted a single-centre randomized placebo-controlled, double-blinded clinical trial from July 2014 to September 2015. We included 192 patients aged [ 18 yr scheduled for elective laparotomy with a planned postoperative stay of C three days. Participants were randomized into two groups to receive either midazolam 3 mg or sodium chloride 0.9% intravenously as premedication prior to surgery. Patients were followed up for up to one week after surgery. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day (POD) 3. The secondary outcomes included the QoR-40 score on POD 7, and the State-Trait Anxiety Inventory, State-Trait Anger Scale, Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale scores. Results The mean (standard deviation) postoperative QoR-40 scores on POD 3 were not significantly different in the midazolam group compared with controls [166.4 (17.0) vs 163.9 (19.8), respectively; mean difference, 2.3; 95% confidence interval,-2.9 to 8.4; P = 0.35]. There were no between-group differences in any of the secondary outcomes. Conclusions Administration of midazolam as premedication for laparotomy patients did not improve the quality of recovery up to one week after surgery. General prescription of midazolam as premedication can be questioned and might only suit some patients. Trial registration www.clinicaltrials.gov (NCT01993459); registered

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Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

Beek¹,

Kroon²,

Rijs³

et al. 2019

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Numerous studies, and a recent meta-analysis including 12 randomized controlled trials, have highlighted the antiemetic properties of benzodiazepines, particularly midazolam, when used in the perioperative period [2627]. Further studies with larger sample sizes and longer follow-ups will be necessary to confirm this potential advantage of triazolam premedication.…”

Section: Discussionmentioning

confidence: 99%

The effect of triazolam premedication on anxiety, sedation, and amnesia in general anesthesia

Pyeon

Chung

Kim

et al. 2017

Korean J Anesthesiol

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BackgroundBenzodiazepines have been used preoperatively as part of an anesthesia regimen to attenuate the anxiety of patients. In this study, we aimed to examine the effect of oral triazolam, a short-acting benzodiazepine, on anxiety, sedation, and amnesia.MethodsNinety patients, aged 20–55 years, were randomly assigned to receive no premedication, or to receive triazolam 0.25 mg or 0.375 mg 1 h before anesthesia. Anxiety score, sedation score, blood pressure, heart rate and psychomotor performance were measured on the evening before surgery and on the day of surgery. Additional tests of psychomotor performance were performed in the postanesthesia care unit and on the next day of surgery. The occurrence of amnesia, bispectral index (BIS), recovery profiles and patient satisfaction with overall anesthesia care were also evaluated.ResultsChanges in the anxiety and sedation scores on the day of surgery were not significantly different among groups, whereas the increases in systolic blood pressure and heart rate were significantly less in both triazolam groups. The triazolam groups both showed a higher incidence of high satisfaction scores (≥ 2). The two triazolam groups also showed similar outcomes, except for a dose-dependent increase in the number of patients with amnesia and BIS values < 90. Delayed recovery from general anesthesia and psychomotor impairment were not observed in the triazolam groups.ConclusionsTriazolam 0.25 mg or 0.375 mg reduced the hemodynamic changes associated with anxiety, produced potent amnesia, and improved patient satisfaction. We suggest that triazolam can be used effectively as anesthetic premedication in adults.

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“…A large number of drugs have been shown in well-designed trials to prophylactically reduce PONV with numbers needed to treat ranging from 2 to 9. [11][12][13][14][15][16][17] It is estimated that even the most effective agents reduce the symptoms in only 25%-30% of those who receive them. Since a patient is likely to experience simultaneous activation of multiple emetogenic pathways, the use of drugs that act on different pathways is logical.…”

Section: Antiemetics: Risks and Benefitsmentioning

confidence: 99%

Ambulatory anesthesia and postoperative nausea and vomiting: predicting the probability

Hegarty

Buckley

McCaul

2016

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Nausea and vomiting are distinctly unpleasant symptoms that may occur after surgery and anesthesia, and high priority is given to their prevention by patients. Research in this area is plentiful and has focused on event prediction and pharmacological prophylaxis but despite this, postoperative nausea and vomiting (PONV) typically occurs in 20%-30% of patients in contemporary practice. Prediction of postoperative and postdischarge nausea and vomiting is particularly important in the ambulatory surgical population as these symptoms may occur following discharge from hospital and continue for up to one week when access to antiemetic therapies is limited. Many of the existing predictive scoring systems are based on data from inpatient populations and limited to the first 24 hours after surgery. Scoring systems based on data from ambulatory surgical populations to predict PONV are only moderately good. The best-performing systems in ambulatory patients are those of Sinclair and Sarin with an area under the receiver operating characteristic curve of 0.78 and 0.74, respectively, but are limited by the short duration of follow-up and a greater emphasis on nausea than vomiting. Given that the ability to predict both PONV and postdischarge nausea and vomiting is clearly limited, emphasis has been placed on prophylactic strategies that incorporate antiemetic medication, intravenous hydration, and nonnarcotic analgesia. PONV has been reduced to <10% in institutions using multimodal approaches. Scoring systems may facilitate "risk tailoring" in which patient risk profile is used as a stratification method for pharmacointervention.

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The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting

Abstract: Administration of preoperative or intraoperative IV midazolam is associated with a significant decrease in overall PONV, nausea, vomiting, and rescue antiemetic use. Providers may consider the administration of IV midazolam as part of a multimodal approach in preventing PONV.

Cited by 63 publications

References 24 publications

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

The effect of midazolam as premedication on the quality of postoperative recovery after laparotomy: a randomized clinical trial

The effect of triazolam premedication on anxiety, sedation, and amnesia in general anesthesia

Ambulatory anesthesia and postoperative nausea and vomiting: predicting the probability

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