Department of Cardiology, Pursaklar State Hospital, Ankara, Turkey.
J Clin Pharm Ther. 2022 Oct;47(10):1644-1649. doi: 10.1111/jcpt.13715. Epub 2022 Jun 28.
Midazolam is one of the most commonly used drugs in procedures requiring sedoanalgesia. It affects the myocardium's ventricular depolarization and repolarization. Previous studies examining the arrhythmogenic effects of midazolam yielded conclusive results. These studies are based on QT and Tp -e distances. The frontal QRS-T angle (f-[QRS-T]a) is a new electro cardiac parameter that shows the heterogeneity of ventricular electrical activity. This study aims to examine the effect of midazolam on f-(QRS- T)a and other depolarization-repolarization parameters in patients who have had cataract surgery.
The study included 177 patients administered midazolam as a sedoanalgesia during cataract surgery. The sedative effect was evaluated 2-3 minutes after a 0.05 mg/kg dose of midazolam was given. Sedation was assessed again by giving 0.5 mg every 2-3 minutes until the desired level of sedation was achieved. 12-lead electrocardiogram (ECG) recordings of all patients were taken just before and immediately after surgery. ECGs were used to calculate the QT interval, QTc interval, Tp -e interval, Tp -e/QT, Tp -e/ QTc ratios and f-(QRS-T)a.
After cataract surgery, f-(QRS-T)a was unchanged compared to presurgery (29.14 ± 4.52 vs. 29.18 ± 5.39, p = 0.852). In addition, no significant change in QT(351.32 ± 21.98 vs. 351.94 ± 22.44, p = 0.091), QTc (384.05 ± 24.52 vs. 385.19 ± 26.12, p = 0.819), Tp -e interval (93.12 ± 9.60 vs. 94.44 ± 8.82, p = 0.179) and Tp -e/QT (0.27 ± 0.02 vs. 0.28 ± 0.03, p = 0.664), Tp -e/ QTc ratios (0.28 ± 0.02 vs. 0.29 ± 0.03, p = 0.655) was observed after surgery when compared to presurgery values. Significant ventricular and supraventricular arrhythmias were not observed in any patient during the operation.
Midazolam did not affect f -(QRS-T) with classical repolarization parameters in patients who underwent cataract surgery, according to this study. Midazolam has been found to be safe for the heart in sedoanalgesia. These results show that sedation with midazolam can be performed without electrocardiogram monitoring.
咪达唑仑是在需要镇静镇痛的程序中最常使用的药物之一。它会影响心肌的心室去极化和复极化。先前检查咪达唑仑致心律失常作用的研究得出了明确的结论。这些研究基于 QT 和 Tp -e 距离。额面 QRS-T 角（f-[QRS-T]a）是一种新的电心脏参数，可显示心室电活动的异质性。本研究旨在检查咪达唑仑对行白内障手术后患者的 f-[QRS-T]a 和其他去极化-复极参数的影响。
该研究纳入了 177 名在白内障手术期间接受咪达唑仑镇静的患者。在给予 0.05mg/kg 咪达唑仑 2-3 分钟后评估镇静效果。每隔 2-3 分钟给予 0.5mg 镇静剂，直至达到所需的镇静水平。所有患者在手术前和手术后立即进行 12 导联心电图（ECG）记录。ECG 用于计算 QT 间期、QTc 间期、Tp -e 间期、Tp -e/QT、Tp -e/ QTc 比值和 f-[QRS-T]a。
与术前相比，白内障手术后 f-[QRS-T]a 没有变化（29.14±4.52 与 29.18±5.39，p=0.852）。此外，QT 无显著变化（351.32±21.98 与 351.94±22.44，p=0.091）、QTc（384.05±24.52 与 385.19±26.12，p=0.819）、Tp -e 间期（93.12±9.60 与 94.44±8.82，p=0.179）和 Tp -e/QT（0.27±0.02 与 0.28±0.03，p=0.664），以及 Tp -e/ QTc 比值（0.28±0.02 与 0.29±0.03，p=0.655）。与术前相比，术后无明显的室性和室上性心律失常。
根据本研究，咪达唑仑在接受白内障手术的患者中并未影响 f-[QRS-T]和经典复极参数。咪达唑仑在镇静镇痛中被发现对心脏是安全的。这些结果表明，咪达唑仑镇静可以在没有心电图监测的情况下进行。
