The effect of midazolam premedication on mental and psychomotor recovery in
geriatric patients undergoing brief surgical procedures.
Author(s): Fredman B, Lahav M, Zohar E, Golod M, Paruta I, Jedeikin R.
Affiliation(s): Department of Anesthesiology and Critical Care, Meir Hospital, Kfar Sava, The
Sackler School of Medicine, Tel Aviv University, Israel.
Publication date & source: 1999, Anesth Analg. , 89(5):1161-6
To assess the effect of IV midazolam premedication on recovery of cognitive
function, 90 geriatric patients (aged 65-81 yr) undergoing brief transurethral
procedures were enrolled into this prospective, placebo-controlled,
double-blinded study. In all cases, a standard general anesthetic was
administered. Thirty minutes before operating room transfer, patients in Group
0.5 mg, Group 2 mg, and Group S received 0.5 mg of midazolam, 2 mg of midazolam,
or an equal volume of saline, respectively. Before study-drug administration
(baseline), at 15 min thereafter, as well as on arrival in the postanesthesia
care unit (PACU), and at 60 min and 120 min, postoperatively, we administered a
digit-symbol substitution test, a mini-mental test, a shape-sorter test, and a
patient-generated 100-mm visual analog score (0 = minimal and 100 = maximal) for
anxiety, sleepiness, and coordination. A 4-point scale was used to assess the
degree of patient sedation at 7, 15, and 30 min after study-drug administration.
Using a modified Aldrete scoring system, PACU discharge was determined by the
PACU staff. Patient anxiety, sleepiness, and coordination scores at baseline and
at 15 min after study-drug administration were similar. When compared with
saline, midazolam was associated with a significantly (P < 0.05) higher incidence
of "deep" sedation. In Group 2 mg, the incidence of a low preoperative Spo2
(<94%) was significantly (P < 0.05) higher when compared with Group S. Emergence,
extubation, and orientation times, as well as time to follow commands were
unaffected by midazolam premedication. Postoperatively, the digit-symbol
substitution test, mini-mental test, and shape-sorter test were similar among the
groups. However, time to PACU discharge was significantly (P = 0.03) longer in
the two midazolam treatment groups (41 +/-25 min, 60 +/- 32 min, 53 +/- 39 min
for Groups S, 0.5 mg, and 2 mg, respectively). Finally, patient satisfaction was
unaffected by the randomization schedule. IMPLICATIONS: IV premedicant midazolam
0.5 mg or 2 mg does not adversely affect mental and psychomotor recovery in
geriatric patients undergoing brief surgical procedures. However, midazolam
administration significantly prolonged postanesthesia care unit discharge time.
Finally, during the preoperative period, midazolam increases the incidence of a
Spo2 <94% in a dose-dependent manner.
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