The use of midazolam and flumazenil in locoregional anaesthesia: an overview

Abstract

Midazolam is useful as an intravenous supplement to local anaesthesia techniques in producing sedation, amnesia and anxiolysis, and has about five times the sedative potency of diazepam. Considerable interpatient variability exists in dose requirements, especially in elderly patients. The combined effects of local anaesthetics and midazolam may contribute to enhanced haemodynamic effects and changes in the respiratory pattern, impairing ventilation and oxygenation. Flumazenil can be titrated in incremental doses to reverse the residual sedative effects of midazolam, without intrinsic haemodynamic or respiratory effects, but may not fully antagonise the decrease in chemoreceptor sensitivity nor the changes in breathing pattern induced by midazolam. Patients treated with epidural or spinal anaesthesia supplemented with midazolam should be monitored to avoid hypoxaemia risks even after the administration of flumazenil.

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases

“…By [18,19] suggest that 0.2 mg kg-' as a sedation dose, which would reflect a potency ratio of 3:1. As further work including studies of the electroencephalographic effects of both drugs to give dose-response curves [20][21][22][23][24] has been carried out, the ratio of potency has been demonstrated to be nearer 5:1. For both drugs the recommendations are to reduce dosage in the elderly, in the case of midazolam to half the normal adult dose or less.…”

A Randomized, Double‐Blind, Placebo‐Controlled Study of Preemptively Administered Intravenous Parecoxib: Effect on Anxiety Levels and Procedural Pain During Epidural Catheter Placement for Surgical Operations or for Chronic Pain Therapy

“…For patients with anxiety, the use of analgesic agents and/or tranquilizer can be helpful. Previous reports have indicated the potential advantage of various sedatives or anesthetics during a painful nerve block, mainly including the ability of a patient to tolerate the procedure with improved comfort and cooperation 16–19 . There are, however, potential complications to the routine use of benzodiazepines, opioids, and ketamine‐induced sedation, including respiratory depression, hemodynamic instability, and prolonged sedation after their cessation 16,20–22 …”

The Analgesic Effect of Betamethasone Administered to Outpatients before Conscious Sedation in Gynecologic and Obstetric Surgery

“…We used midazolam for its greater amnesia effect, rapid onset of action, and quick recovery time. Moreover, benzodiazepines reduced the risks associated with the use of local anesthetics (arrhythmias and convulsions) 21–24 …”