Summary
Midazolam is a short-acting water soluble benzodiazepine derivative. It is a hypnotic used for intravenous anaesthesia induction. The present investigation was designed in a prospective double-blind fashion to compare midazolam with thiopentone as hypnotic components in balanced anaesthesia. The study included 50 healthy patients undergoing relatively short surgical procedures. The results revealed that thiopentone is faster in onset than midazolam for induction of anaesthesia, with less variation of dose response. However, maintenance of anaesthesia was superior with midazolam, requiring fewer supplemental anaesthetic drugs, having better patient acceptance and providing more amnesia. Postoperative complications were very low with both techniques. Midazolam was surprisingly similar to thiopentone in most parameters including emergence time from anaesthesia. Midazolam is a new drug with potential both for induction of anaesthesia and maintenance of balanced anaesthesia.
Résumé
Le midazolam est un dirivé hydrosoluble de la benzodiazépine à action courte qui peut être employé par la voie veineuse pour l’induction de l’anesthésie. On compare dans la présente étude les effets hypnotiques du midazolam avec ceux du thiopental lors de l’anesthésie générale balancée en utilisant une méthode prospective à double insu. L’étude englobe cinquante patients en bon état subissant des interventions d’une durée relativement courte. Les résultats montrent qu’à l’induction, l’action du thiopental débute plus rapidement que celle du midazolam et que la relation dose-effet est moins variable.
Cependant, pour le maintien de l’anesthésie, le midazolam a été considéré supérieur. Moins d’agents anesthésiques supplémentaires ont été requis, l’acceptance par le patient a été plus grande et l’amnésie supérieure. Avec les deux techniques, les complications ont été très minimes. La comparaison de la plupart des paramètres incluant la durée de la période de réveil démontre la suprenante similarité des deux agents. En conclusion, le midazolam est un nouvel agent qui pourrait s’avérer très utile pour l’induction et ce maintien de l’anesthésie générale balancée.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Conner, J.T., Katz, R.L., Pagano, R.R. &Graham, C.W. RO 21-3981 for intravenous surgical premedication and induction of anesthesia. Anesth. Analg.57: 1–5 (1978).
Revés, J.G., Corssen, G. &Holcomb, C. Comparison of two benzodiazepines for anesthesia induction: Midazolam and Diazepam. Canad. Anaesth. Soc. J.3: 211–214 (1978).
Brown, C.R.,Sarnquist, F.H. &Pedley, T.A. RO 21-2981: clinical, electrocephalographic and pharmacokinetic study (abstract). Annual Meeting Am. Soc. Anes., p. 241 (1977).
Fragen, R.J., Gahl, F. &Caldwell, N. A water soluble benzodiazepine, Ro 21-3981, for induction of anesthesia. Anesthesiology49: 41–43 (1978).
Lundy, J.F. Balanced anesthesia. Minnesota Medicine9: 399–404 (1926).
Woodbridge, P.D. Changingconcepts concerning depth of anesthesia. Anesthesiology18: 536–550 (1957).
Puglisi, C.V. Meyer, J.C., D’Arconte, L., Brooks, M.A. &de Silva, J.A.F. Determination of water soluble imidazo-1,-4-benzodiazepines in blood by electron-capture gas-liquid chromatography and in urine by differential pulse polarography. J. Chromatogr.145: 81–96 (1978).
Kaplan, S.A., Jack, M.L., Alexander, K. &Weinfeld, R.D. Pharmacokinetic profile of diazepam in man following single intravenous and oral and chronic oral administrations. J. Pharm. Sci.62: 1789–1796 (1973).
Brown, S.S, &Dundee, J.W. Clinical studies of induction agents XXV: diazepam. Brit. J. Anaesth.40: 108–112 (1968).
Dundee, J.W., Haslett, W.H.K. The benzodiazepines, a review of their actions and uses relative to anaesthetic practice. Brit. J. Anaesth.42:217–234 (1970).
Fox, G.S., Wynands, J.R. &Bhambham, M. A clinical comparison of diazepam and thiopentone as induction agents to general anaesthesia. Canad. Anaesth. Soc. J.15: 281–290 (1968).
Hellewell, J. Induction of anaesthesia with diazepam inDiazepam in Anesthesia. Edited by Knight, P.R. and Burgess, C.G., Bristol, England, John Wright and Sons, pp. 47–51 (1968).
Wyant, G.M. &Studney, L.J. A study of diazepam (Valium) for induction of anaesthesia. Canad. Anaesth. Soc. J.17: 166–171 (1970).
Beaulieu, D., Goyette, M. &Keeri-Szanto. Anaesthetic time/dose curves; VI. Experiences with diazepam. Canad. Anaesth. Soc. J.14: 326–331 (1967).
Dechene, J.P. &Desrosiers, R. Diazepam in pulmonary surgery. Canad. Anaes. Soc. J.16: 162–166 (1969).
Greenblatt, D.J. &Shader, R.I.Benzodiazepines in Clinical Practice. New York, Raven Press, pp. 104–106 (1974).
Nagai, S.H., Tseng, D.S.C. &Wang, S.C. Effect of diazepam and other central nervous system depressants on spinal reflexes in cats: a study of site of action. J. Pharmacol. Exp. Ther.153: 344–351 (1966).
Feldman, S.A. &Crawley, B.E. Preliminary communications — interaction of diazepam with the muscle-relaxant drugs. Br. Med. J.2: 336–338 (1970).
Dretchen, K.,Ghoneim, M.M. &Long, J.P. The interaction of diazepam with myoneural blocking agents. Anesthesiology34: 463–468.
Hollis, D.A. Diazepam as an induction agent, II, inDiazepam In Anesthesia. Edited by Knight, P.R. and Burgess, G.G., Bristol, England, John Wright and Sons, pp. 60–65 (1968).
Ghoneim, M.M. &Van Hamme, M.J. Pharmacokinetics of thiopental: the effects of enflurane and nitrous oxide anesthesia and surgery (abstract). Annual Meeting Am. Soc. of Anes. pp. 425–426 (1977).
Woo, G.K., Kolis, S.J. &Schwartz, M.A.In vitro metabolism of an imiadazobenzodiazepine. The Pharmacologist19: 164 (1977).
Greenblatt, D.J. &Shader, R.I.Benzodiazepines in Clinical Practice. New York, Raven Press, pp. 204–205 (1974).
Stovner, J. &Endresen, R. Intravenous anaesthesia with diazepam: Acta Anesth. Scand. supp. 24, pp. 223–227 (1966).
Pagano, R.R., Graham, C.W., Galligan, K., Conner, J.T. &Katz, R.L. Histopathology of veins after intravenous lorazepam and RO 21-3981. Canad. Anaesth. Soc. J.25: 50–52 (1978).
Author information
Authors and Affiliations
Additional information
Supported by a Grant from Hoffmann/LaRoche Incorporated.
Rights and permissions
About this article
Cite this article
Reves, J.G., Vinik, R., Hirschfield, A.M. et al. Midazolam compared with thiopentone as a hypnotic component in balanced anaesthesia: A randomized, double-blind study. Canad. Anaesth. Soc. J. 26, 42–49 (1979). https://doi.org/10.1007/BF03039453
Issue Date:
DOI: https://doi.org/10.1007/BF03039453