Abstract
Purpose
A double-blind study was undertaken to evaluate the influence of graded doses of midazolam on propofol infusion requirements, recovery characteristics and the quality of recovery, associated with propofol/alfentanil/O2 total intravenous anaesthesia (TIVA).
Methods
Ninety ASA Class I and II subjects scheduled for arthroscopic knee surgery were randomly allocated to receive either placebo (Group PLAC), or midazolam doses of 15, 30 or 45 μg·kg−1 (Groups M-15, M-30 and M-45, respectively). Anaesthesia was induced and maintained with propofol (infused initially at 100 μg·kg−1· min−1, and adjusted thereafter according to anaesthetic depth) and alfentanil (loading dose of 20 μg·kg−1, followed by infusion at 0.5 μg·kg−1· min−1). Postoperatively, times to awakening, recovery, and discharge were evaluated, in addition to psychometric evaluations using the Trieger Dot Test (TDT).
Results
The study was discontinued prematurely, as six patients unexpectedly experienced intraoperative awareness with recall (4/21 = 19.1% of patients with PLAC vs 2/69 = 2.9% of patients in the midazolam groups, P < 0.04). Induction requirements of propofol were found to be lower in the M-30 and M-45 groups when compared with PLAC (P < 0.05), whereas propofol infusion requirements were similar among groups. Times to awakening and discharge from the Recovery Room and Day Care Unit, as well as TDT scores, were no greater in any midazolam group than in PLAC.
Conclusions
Midazolam 30–45 μg·kg−1 decreases the amount of propofol required for anaesthetic induction, without influencing recovery profiles or patient discharge times from the Day Care Unit. Despite careful modulation of the propofol infusion rate, six patients unexpectedly experienced intraoperative awareness with recall, with the lowest incidence occurring in those groups where patients had received midazolam.
Résumé
Objectif
Évaluer l’influence du midazolam à doses croissantes sur la quantité de propofol requise en perfusion, et sur les caractéristiques et la qualité du réveil pendant une anesthésie intraveineuse totale au propofol/alfentanyl/O2 (AIVT).
Méthodes
Quatre-vingt-dix sujets de classe ASA I et II devant subir une chirurgie arthroscopique du genou étaient répartis au hasard pour recevoir soit un placebo (Groupe PLAC), soit du midazolam à des doses de 15, 30 ou 45 μg·kg−1 (Groupes M-15, M-30 et M-45). L’anesthésie était induite et entretenue au propofol (en perfusion initiale de 100 μg·kg−1·min−1 et ensuite réglée d’après la profondeur de l’anesthésie) et à l’alfentanil (dose de charge de 20 μg·kg−1 suivie par une perfusion de 0,5 μg·kg−1·min−1). En postopératoire, le temps du réveil, de la récupération et du congé était enregistré en plus d’une évaluation psychométrique au Trieger Dot Test (TDT).
Résultats
Six patient ayant éprouvé une reprise inattendue peropératoire de la conscience, l’étude a été arrêtée pré-maturément (4/21 = 19,1% des patients avec PLAC vs 2/69 = 2,9% des patients des groupes midazolam, P < 0,04). Pour l’induction, les besoins en propofol étaient inférieurs dans les groupe M-30 et M-45 comparativement au groupe PLAC (P < 0,05), alors que les quantités de propofol requises en perfusion étaient identiques pour tous les groupes. La durée du réveil et du séjour en salle de réveil et à l’unité de chirurgie de jour n’était pas plus longue et les scores du TDT plus élevés dans les groupes midazolam que dans le groupe PLAC.
Conclusion
Le midazolam 30–45 μg·kg−1 diminue la dose de propofol requise pour l’induction sans influencer le profit de la récupération et du congé de l’unité de jour. Malgré un modulation minutieuse de la vitesse de perfusion, six patients ont éprouvé une reprise de conscience inattendue avec rappel dont la plus basse incidence est survenue dans les groupes recevant du midazolam.
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Supported by a Research Grant from Hoffmann-La Roche, Canada.
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Miller, D.R., Blew, P.G., Martineau, R.J. et al. Midazolam and awareness with recall during total intravenous anaesthesia. Can J Anaesth 43, 946–953 (1996). https://doi.org/10.1007/BF03011809
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DOI: https://doi.org/10.1007/BF03011809