Nishiyama T, Odaka Y, Hirasaki A, Seto K
Department of Anesthesiology, Kagawa Prefectural Central Hospital, Takamatsu.
Masui. 1991 Sep;40(9):1353-8.
Postoperative pain relief and sedation with epidural midazolam were studied. Twenty-one patients for elective upper abdominal surgery were divided into 3 groups. Epidural catheter was inserted into thoracic epidural space before induction of general anesthesia. In each group, either 10 ml saline only, midazolam 0.05 mg.kg-1 + 10 ml saline, or midazolam 0.1 mg.kg-1 + 10 ml saline was injected into epidural catheter for complaint of pain in recovery room. For 120 minutes after epidural injection, blood pressure, heart rate, respiratory rate, serum concentration of midazolam, and sedation score were monitored. In midazolam injected groups, only slight changes were seen in blood pressure, heart rate, and respiratory rate. Sedation score was graded from 1 to 6:1 means complete sleep, and not responded to verbal command, 6 means agitated and many complaints. Midazolam 0.1 mg.kg-1 + 10 ml saline group had the lowest score, and saline 10 ml group had the highest score. Prolonged sedation and pain relief were obtained in midazolam injected group, especially 0.1 mg.kg-1 + 10 ml saline group. Serum midazolam concentrations were lower than 200 ng.ml-1. These values were considered as the lower limit for sedation by intravenous administration. In conclusion, epidural midazolam was useful for postoperative pain relief. The mechanism is considered to involve spinally mediated CNS action or direct spinal action.
研究了硬膜外注射咪达唑仑用于术后镇痛和镇静的效果。21例择期上腹部手术患者被分为3组。在全身麻醉诱导前，将硬膜外导管插入胸段硬膜外间隙。在恢复室，当患者主诉疼痛时，每组分别向硬膜外导管内注入10 ml生理盐水、0.05 mg·kg-1咪达唑仑 + 10 ml生理盐水或0.1 mg·kg-1咪达唑仑 + 10 ml生理盐水。硬膜外注射后120分钟内，监测血压、心率、呼吸频率、咪达唑仑血清浓度和镇静评分。在注射咪达唑仑的组中，血压、心率和呼吸频率仅有轻微变化。镇静评分从1至6级：1表示完全睡眠，对言语指令无反应，6表示烦躁且有许多主诉。0.1 mg·kg-1咪达唑仑 + 10 ml生理盐水组得分最低，10 ml生理盐水组得分最高。注射咪达唑仑的组，尤其是0.1 mg·kg-1 + 10 ml生理盐水组，获得了延长的镇静和镇痛效果。血清咪达唑仑浓度低于200 ng·ml-1。这些值被认为是静脉给药镇静的下限。总之，硬膜外注射咪达唑仑对术后镇痛有效。其机制被认为涉及脊髓介导的中枢神经系统作用或直接的脊髓作用。
