Nishiyama Tomoki, Matsukawa Takashi, Hanaoka Kazuo
Surgical Center, The Institute of Medical Science, The University of Tokyo, Japan.
J Clin Anesth. 2002 Mar;14(2):92-7. doi: 10.1016/s0952-8180(01)00347-6.
To investigate the interaction of midazolam with different doses of bupivacaine, by comparing the analgesic, sedative, and amnesic effects of continuous epidural midazolam with two different doses of bupivacaine.
Prospective, randomized study.
Operating room and intensive care units of a university hospital.
100 ASA physical status I and II postgastrectomy patients (40-70 yrs) without any complications.
Patients were divided into four groups (n = 25) and administered continuous thoracic epidural infusion (40 mL/12 hr) of the drugs via a balloon infuser. The contents of the infuser (40 mL) were bupivacaine 180 mg with midazolam 20 mg (HM group), 90 mg with midazolam 20 mg (LM group), 180 mg without midazolam (HC group), or 90 mg without midazolam (LC group). As a rescue medication, 50 mg indomethacin suppository was the first choice, then IM pentazocine 15 mg.
Analgesia and sedation scores, blood pressure (BP), heart rate, respiratory rate, oxygen saturation, amnesia, the number of rescue medications, and time to the first rescue medication were monitored. The area under the curves (AUCs) of analgesia and sedation scores, and BP were calculated.
In the HM group, significantly better analgesia and sedation were obtained and the number of rescue medications given was the lowest of the four groups. The time to the first rescue medication was longest in the HM group, followed by the LM group, then the HC, and, finally, LC groups. The numbers of the patients with amnesia were greater in the HM and LM groups than the HC and LC groups. Blood pressure decreased significantly in the HM group but no treatment was necessary. The AUCs of analgesia and sedation scores, and BP were lowest in the HM group.
Adding midazolam increased not only analgesic but also sedative effect with increasing dose of bupivacaine in a postoperative continuous epidural administration.
通过比较持续硬膜外给予咪达唑仑与两种不同剂量布比卡因的镇痛、镇静和遗忘效果，研究咪达唑仑与不同剂量布比卡因的相互作用。
前瞻性随机研究。
大学医院的手术室和重症监护病房。
100例胃切除术后ASA身体状况I级和II级（40 - 70岁）且无任何并发症的患者。
将患者分为四组（每组n = 25），通过球囊输注器持续进行胸部硬膜外输注（40 mL/12小时）药物。输注器内的内容物（40 mL）分别为含咪达唑仑20 mg的布比卡因180 mg（HM组）、含咪达唑仑20 mg的布比卡因90 mg（LM组）、不含咪达唑仑的布比卡因180 mg（HC组）或不含咪达唑仑的布比卡因90 mg（LC组）。作为急救药物，首选50 mg吲哚美辛栓剂，然后是15 mg喷他佐辛肌内注射。
监测镇痛和镇静评分、血压（BP）、心率、呼吸频率、血氧饱和度、遗忘情况、急救药物数量以及首次使用急救药物的时间。计算镇痛和镇静评分以及血压的曲线下面积（AUC）。
HM组获得了显著更好的镇痛和镇静效果，且给予的急救药物数量是四组中最少的。HM组首次使用急救药物的时间最长，其次是LM组，然后是HC组，最后是LC组。HM组和LM组遗忘患者的数量多于HC组和LC组。HM组血压显著下降，但无需治疗。HM组镇痛和镇静评分以及血压的AUC最低。
在术后持续硬膜外给药中，随着布比卡因剂量增加，添加咪达唑仑不仅增强了镇痛效果，还增强了镇静效果。
