Department of Anesthesia, Kosei General Hospital, Tokyo, Japan.
J Anesth. 2010 Dec;24(6):869-76. doi: 10.1007/s00540-010-1017-z. Epub 2010 Sep 17.
Conscious sedation with intravenous sedative-hypnotic drugs has the advantage of relaxing patients before invasive procedures. Preoperative anxiety has been suggested to correlate with postoperative comfortableness. In this study, we chose midazolam and droperidol as well-established intravenous sedative-hypnotic drugs. We evaluated the preoperative anxiolytic effect on postoperative memories and emotions up to the first postoperative morning.
In a prospective, double blind study, 120 patients requiring epidural anesthesia were randomly assigned to one of three groups to receive saline, midazolam (0.04 mg/kg), or droperidol (0.1 mg/kg). Cardiovascular and respiratory measurements, observer's assessment of alertness/sedation scale, level of anxiety and discomfort of the patients, pain during the infiltration of local anesthetics, and incidence of adverse effects were recorded. Amnesia, anxiety, and discomfort during the epidural procedure were re-assessed between 12 and 20 h postsurgery.
Patients who received sedatives were significantly more sedated (P < 0.0001), but the pain score was significantly higher in the droperidol group (P = 0.0007) at epidural catheterization. On the first postoperative morning, patients receiving midazolam had a significantly lower pain score (P < 0.0001) with less anxiety and discomfort. Patients in both the midazolam and droperidol groups showed a significant decrease in blood pressure (P < 0.0167), but no respiratory impairment. No adverse effects were experienced throughout the study period.
Conscious sedation with intravenous midazolam 0.04 mg/kg significantly decreased the anxiety and discomfort scores of the patients on the day following surgery but had no effect on these immediately following the epidural catheterization procedure.
静脉镇静催眠药物的镇静作用可在侵入性操作前使患者放松。术前焦虑被认为与术后舒适度相关。在这项研究中，我们选择了咪达唑仑和氟哌利多作为既定的静脉镇静催眠药物。我们评估了术前镇静对术后记忆和情绪的影响，直至术后第一清晨。
前瞻性、双盲研究中，120 例需行硬膜外麻醉的患者随机分为三组，分别接受生理盐水、咪达唑仑（0.04mg/kg）或氟哌利多（0.1mg/kg）。记录心血管和呼吸测量、观察者警觉/镇静评分、患者焦虑和不适程度、局部麻醉浸润时的疼痛以及不良反应的发生率。在术后 12-20 小时再次评估硬膜外操作期间的遗忘、焦虑和不适。
接受镇静剂的患者镇静程度显著更高（P<0.0001），但在硬膜外导管置入时，氟哌利多组的疼痛评分显著更高（P=0.0007）。在术后第一清晨，接受咪达唑仑的患者疼痛评分显著更低（P<0.0001），焦虑和不适程度更低。咪达唑仑和氟哌利多组患者的血压均显著下降（P<0.0167），但无呼吸抑制。整个研究期间无不良反应发生。
静脉给予咪达唑仑 0.04mg/kg 进行镇静可显著降低术后第一天患者的焦虑和不适评分，但对硬膜外导管置入后即刻无影响。
