Gupta Roshni, Santha Neeta, Upadya Madhusudan, Manissery Jesni Joseph
Consultant, BL Kapoor Hospital, Rajendra Palace, Delhi, India.
Assistant Professor, Department of Anaesthesiology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India.
J Clin Diagn Res. 2017 Aug;11(8):UC01-UC04. doi: 10.7860/JCDR/2017/26414.10381. Epub 2017 Aug 1.
Benzodiazepines primarily acts on the central nervous system. Most patients are extremely anxious in the pre-operative period. Excessive anxiety adversely influences anaesthetic induction and often leads to functional impairment and poor recovery after surgery.
To determine whether amnesia, anxiety, sedation and cardio respiratory symptoms are affected while administering two different doses of intravenous midazolam (0.02 mg/kg & 0.06 mg/kg).
Two forty patients posted for head and neck surgeries were involved in this double blinded prospective randomised controlled trial. The patients were randomized into two main groups, Group 1 receiving 0.02 mg/kg and Group 2 receiving 0.06 mg/kg midazolam intravenously as premedication. Visual recognition and recall were tested using eight laminated A4 size posters pre-operatively and four further images were shown at the postoperative interview. Anxiety was evaluated by a Visual Analogue Scale (VAS) and sedation depth was determined by the Observer's Assessment of Alertness/Sedation Scale (OAAS) scale. Vital signs including heart rate, respiratory rate, mean blood pressure and arterial oxygen saturation (SpO) were monitored. Statistical analysis was done using paired Student's t-test and Chi-square test.
VAS scores were lower in Group 2 (0.06 mg/kg) than in Group 1 (0.02 mg/kg) at T (15 minutes after the injection of midazolam). Comparison of OAAS scores among Group 1 and Group 2 showed that more patients in Group 1 were alert at T15 compared to Group 2. Recall of events was significantly lower in Group 2 compared to Group 1. There was no significant statistical variation in haemodynamic parameters between the groups except for decreased diastolic blood pressure and room air saturation in Group 2.
A higher dosage of midazolam improves the quality of anxiolysis and sedation with lesser rates of intraoperative recall and maintains haemodynamic stability.
苯二氮䓬类药物主要作用于中枢神经系统。大多数患者在术前极度焦虑。过度焦虑会对麻醉诱导产生不利影响，并常常导致功能障碍以及术后恢复不佳。
确定给予两种不同剂量的静脉注射咪达唑仑（0.02mg/kg和0.06mg/kg）时，遗忘、焦虑、镇静及心肺症状是否会受到影响。
40例拟行头颈外科手术的患者参与了这项双盲前瞻性随机对照试验。患者被随机分为两个主要组，第1组静脉注射0.02mg/kg咪达唑仑作为术前用药，第2组静脉注射0.06mg/kg咪达唑仑作为术前用药。术前使用8张A4尺寸的层压海报测试视觉识别和回忆能力，术后访视时再展示4张图片。采用视觉模拟量表（VAS）评估焦虑程度，通过观察者警觉/镇静评分量表（OAAS）确定镇静深度。监测包括心率、呼吸频率、平均血压和动脉血氧饱和度（SpO）在内的生命体征。采用配对t检验和卡方检验进行统计分析。
在T时间点（注射咪达唑仑15分钟后），第2组（0.06mg/kg）的VAS评分低于第1组（0.02mg/kg）。第1组和第2组的OAAS评分比较显示，与第2组相比，第1组在T15时更多患者处于清醒状态。与第1组相比，第2组对事件的回忆明显更低。除第2组舒张压和室内空气饱和度降低外，两组间血流动力学参数无显著统计学差异。
较高剂量的咪达唑仑可提高抗焦虑和镇静质量，术中回忆率较低，并维持血流动力学稳定。
