Intensive Care Medicine

, Volume 17, Supplement 1, pp S20–S23 | Cite as

Sedation in the ICU

  • H. R. Vinik
  • I. Kissin


The effect of midazolam on the induction dose-response curve for alfentanil was studied in non-premedicated ASA physical status I or II patients. The response to the verbal command was used as an end point of anaesthesia. Dose-response curves for midazolam, alfentanil, and their combination were determined with a probit procedure, and compared with algebraic (fractional) analysis of drug interaction. Interaction between midazolam and alfentanil was found to be synergistic (supra-additive). The results suggest that the use of this combination is advantageous not only because it helps to achieve different anaesthetic goals with specific drugs (a benzodiazepine for unconsciousness and an opioid for blockade of the responses to noxious stimulation), but also because its components are complementary for unconsciousness.

Key words

Intravenous anaesthetics Analgesics Hypnotics Benzodiazepines Drug interactions Midazolam Alfentanil 


  1. 1.
    D'Coppel Kyoto, Japan (1989) Critical care symposiumGoogle Scholar
  2. 2.
    Farina ML, Levati A, Tognoni G (1981) A multicentre study of ICU drug utilization. Intensive Care Med 7:125–131Google Scholar
  3. 3.
    Rosen D, Rosen K (1989) Midazolam infusion in the pediatric ICU. In: Vinik HR (ed) Midazolam infusion for anesthesia and intensive care. Excerpta Medica, PrincetonGoogle Scholar
  4. 4.
    Persson MP, Nillson A, Hartvig P (1988) Relation and amnesia to plasma concentrations of midazolam in surgical patients. Clin Pharmacol Ther 43:324–331Google Scholar
  5. 5.
    Brown SS, Dundee JW (1968) Clinical studies of induction agents XXV: diazepam. Br J Anaesth 40:108–112Google Scholar
  6. 6.
    Vinik HR, Bradley EL, Jr, Kissin I (1989) Midazolam-alfentanil synergism for anesthesia induction in patients. Anesth Analg 69:213–217Google Scholar
  7. 7.
    Vinik HR, Shaw, Bradley EL, Jr, Kissin I (1989) Effect of alfentanil on midazolam dose-response curve for induction of anesthesia in patients. Anesthesiology 71:A118Google Scholar
  8. 8.
    Lorens SA, Sainati SM (1978) Naloxone blocks the excitatory effect of ethanol and chlordiazepoxide on lateral hypothalamic selfstimulation behavior. Life Sci 23:1359–1364Google Scholar
  9. 9.
    McDonnell TE, Bartkowski RR, Williams JJ (1984) ED50 of alfentanil for induction of anesthesia in unpremedicated young adults. Anesthesiology 60:136–140Google Scholar
  10. 10.
    Silbert BS, Rosow CE, Keegan CR et al. (1986) The effect of diazepam on induction of anesthesia with alfentanil. Anesth Analg 65:71–77Google Scholar
  11. 11.
    Gamble JAS, Kawar P, Dundee JW et al. (1981) Evaluation of midazolam as an intravenous induction agent. Anaesthesia 36:868–873Google Scholar
  12. 12.
    Silbert BS, Rosow CE, Keegan CR, Latta WB, Murphy Al, Moss J, Philbin DM (1986) The effect of diazepam on induction of anesthesia with alfentanil. Anesth Analg 65:71–77Google Scholar
  13. 13.
    Halliday NJ, Dundee JW, Harper KW (1985) Influence of fentanyl and alfentanil pretreatment on the action of midazolam. Br J Anaesth 57:351–352Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • H. R. Vinik
    • 1
  • I. Kissin
    • 1
  1. 1.Department of AnesthesiologyThe University of Alabama at BirminghamBirminghamUSA

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