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Showing 10 results for Midazolam
Rectal premedication in pediatric anesthesia: midazolam versus ketamine
Ebrahim Soltani A, Arbabi Sh, Nahvi H, Moshirian N,
Volume 66, Issue 2 (5-2008)
Abstract

Background: Premedication is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. The rectal route is one of the most commonly accepted means of drug administration. The aim of our study was to investigate and compare the efficacy of rectally administered midazolam versus that of ketamine as a premedication in pediatric patients.

Methods: We performed a prospective randomized double-blinded clinical trial in 64 children, 1 to 10 years of age, randomly allocated into two groups. The midazolam group received 0.5 mg/kg rectal midazolam and the ketamine group received 5 mg/kg rectal ketamine. The preoperative sedation scores were evaluated on a three-point scale. The anxiolysis and mask acceptance scores were evaluated separately on a four-point scale, with ease of parental separation, based on the presence or lack of crying, evaluated on a two-point scale.

Results: Neither medication showed acceptable sedation (>75%), with no significant difference in sedation score between the two groups (P=0.725). Anxiolysis and mask acceptance using either midazolam or ketamine were acceptable, with  midazolam performing significantly better than ketamine (P=0.00 and P=0.042, respectively). Ease of parental separation was seen in both groups without significant difference (P=0.288) and no major adverse effects, such as apnea, occurred in either group.

Conclusions: Rectal midazolam is more effective than ketamine in anxiolysis and mask acceptance. Although they both can ease separation anxiety in children before surgery, we found neither drug to be acceptable for sedation.


The effect of hypnotic drug type on anesthetic depth and amnesia: a randomized clinical trial
Amiri Hr, Makarem J, Noyan Ashraf Ma,
Volume 67, Issue 3 (6-2009)
Abstract

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Bispectral index (BIS index) shows the depth of anesthesia. The effects of drugs on BIS and amnesia are different. This study was performed to evaluate the association between two different sedative regimens on BIS and amnesia.
Methods: In this clinical trial, 60 patients who needed elective orthopedic surgery under regional anesthesia with intravenous sedation were elected. Patients divided in two equal groups based on sedation protocol by block randomization method: midazolam plus fentanyl group (MF group) or propofol group (P group). Dose of sedative drugs were adjusted according to clinical findings of sedation. Depth of sedation in all patients, preserved in four based on modified Ramsey Sedation Score. Patients questioned about spontaneous recall after full awakening in recovery room. Recall of any event during operation considered as failed amnesia. Correlation of BIS index with recall was measured in two different groups separately.
Results: The frequency of recall was 2 (6.7%) in P group and 10 (33.3%) in MF group (p=0.01). The mean± SD of BIS in P group was 76±5 (68-91) and in MF group was 93.4±5 (77-98) (p<0.001). The difference of BIS in patients without amnesia (p=0.019) and with amnesia (p<0.001) in two groups were significant, respectively. No delay in recovery was observed.
Conclusion: Although the Modified Ramsey Sedation Score and clinical sedation indices were the same, but BIS in patients varied in a wide range. Hypnotic drug was a main determinant of BIS score and amnesia.


Midazolam versus ketamine in the management of emergence agitation in children undergoing lower abdominal and limb surgeries
Khalili Gr, Sajedi P, Danesh H,
Volume 69, Issue 11 (2-2012)
Abstract

Background: Emergence agitation (EA) is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years.

Methods: In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam (28) or 0.5 mg/kg ketamine (29) by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation (agitation score), severity of pain (pain score), anesthesia, recovery and extubation durations were recorded postoperatively.

Results: The prevalence of agitation in midazolam (21.4%) was lower than ketamine group (34.5% P<0.05). In addition, the duration of agitation in ketamine group (21±16.67 min) was significantly higher than midazolam group (6.83±6.55 min), (P<0.05). However, no significant differences were seen in agitation score, pain score, anesthesia, recovery or extubation durations in the two groups (P>0.05).

Conclusion: The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children.


The comparison of efficacy and complications of two premedication agents, midazolam-ketamine and midazolam-fentanyl in adult patients who underwent cataract surgery
Mehdi Sanatkar , Mehrdad Goudarzi ,
Volume 77, Issue 3 (6-2019)
Abstract
Background: Cataract is one of the most common eye diseases especially in children and adolescents in two age ranges, and many of these patients need to surgery throughout life. The purpose of this study was to compare the efficacy and side effects of midazolam-ketamine and midazolam-fentanyl for sedation in adult cataract surgery.
Methods: In this study, which was a case-control study, 80 patients were referred to Farabi Hospital in Tehran from November to December 2018 for cataract surgery and underwent surgery. The patients were divided into two groups (n=40). In this study the method of using midazolam-ketamine (ketamine group) was compared with the combination of midazolam-fentanyl (fentanyl group). The hemodynamic variables such as blood pressure and heart rate before surgery were measured and then measured every 5 minutes during operation and were recorded. In addition to hemodynamic variables, other variables such as agitation, surgeon satisfaction, recovery nurse satisfaction, degree of oxygen saturation during surgery, and nausea and vomiting were compared between the two groups.
Results: In this study, 18 patients (45%) of fentanyl group and 17 patients (42.5%) of ketamine group were female. Patients in the two groups had similar demographic distribution before surgery. In this study about blood pressure after surgery, from 80 patients, 22 cases had blood pressure below 119.79 mmHg, of which 3 (13.6%) cases were in ketamine group and 19 cases (86.4%) in fentanyl group. In general, 7.5% of ketamine group and 47.5% of fentanyl group had a blood pressure lower than 119.79 mmHg. Hemodynamic changes and hypotension after sedation was more in fentanyl group. Two groups did not differ in terms of heart rate, arterial oxygen saturation during surgery, surgeon satisfaction during surgery, and postoperative nausea and vomiting.
Conclusion: Administration of ketamine-midazolam versus fentanyl-midazolam in patients who underwent cataract surgery by sedation led to more stable hemodynamic variables intraoperatively and other side effects such as heart rate, oxygen saturation, surgeon satisfaction, nausea and vomiting were similar between two groups.

Comparison of the efficacy of two pre-treatment medication of dexmedetomedine-fentanyl and midazolam-fentanyl in cataract surgery
Mehdi Sanatkar , Mehrdad Goudarzi , Ebrahim Espahbodi ,
Volume 78, Issue 3 (6-2020)
Abstract
Background: Cataract is one of the most common eye diseases especially in elderly patients and most of these patients require surgery. In the process of sedation, different drugs are used, each with its advantages and disadvantages. Dexmedetomidine is one of the drugs that has recently received special attention for sedation. In this study, we compared the drug combination of dexmedetomidine-fentanyl with midazolam-fentanyl in cataract surgery.
Methods: In a case-control study, the patients who underwent cataract surgery by a surgeon with topical anesthesia and sedation techniques were included in the target group. Seventy patients were divided into two groups of 35 according to a random number table. One group received dexmedetomidine-fentanyl (dexmedetomidine group) and the other received midazolam-fentanyl (midazolam group). Age, sex, weight, systolic and diastolic blood pressure, heart rate, patient sedation, surgeon satisfaction, recovery nurse satisfaction, and postoperative nausea and vomiting were compared between the two groups. The study was performed in the Farabi Hospital, Tehran, Iran, from October to November 2019.
Results: Patients in the two groups were similar in age, sex, weight, and preoperative hemodynamic variables. There was no significant difference in preoperative systolic and diastolic blood pressure between the two groups (P=0.150). However, those who received dexmedetomidine had significantly lower intraoperative heart rate (P<0.001). The difference in postoperative systolic and diastolic blood pressure as well as postoperative heart rate was significantly lower in the dexmedetomidine group (P<0.001). There was no statistically significant difference between the two groups in postoperative sedation (P=0.93). The surgeon’s satisfaction was no significant difference between the two groups (P=0.17). Also, the rate of recovery nurse satisfaction was not significantly different between the two groups (P=0.21). The incidence of nausea and vomiting was similar in both groups (P=1.00).
Conclusion: Sedation with dexmedetomidine decreases blood pressure and heart rate. Therefore, it is recommended to use dexmedetomidine more cautiously in patients with unstable hemodynamics and especially in short surgical procedures.

A comparison of sedation quality with midazolam-ketamine versus propofol-ketamine during Phacoemulsification surgery
Hamidreza Shetabi, Seyed Morteza Haidari , Darush Moradi Farsani , Zahra Bechari,
Volume 79, Issue 1 (4-2021)
Abstract
Background: Phacoemulsification surgery is one of the most common surgeries in the world. Various drugs have been used alone or in combination with each other to provide effective and safe sedation in patients, but so far, a drug method agreed upon by anesthesiologists has not been proposed. The purpose of this research was to evaluate the sedative quality of midazolam or propofol with a low dose of ketamine in phacoemulsification surgery.
Methods: This study was a double-blind randomized clinical trial conducted from November 2017 to August 2019 at Faiz Hospital, Isfahan. In this study, 68 patients were assigned in the groups of midazolam (M) and propofol (P) using randomization software entered the study. The midazolam (M) group received 0.04 mg/kg and the propofol (P) group received 0.5 mg/kg, then in both groups, ketamine 0.3 mg/kg was injected intravenously. The quality of sedation, cardiovascular response and patient and surgeon satisfaction were assessed and recorded. Data were entered into SPSS 23 software and analyzed by using ANOVA and Independent samples t‐test.
Results: In this study, between the two groups in terms of demographic characteristics there was no significant difference (P>0.05). In the KM group, higher percentage of patients achieved the desired quality of sedation, but, between the two groups no statistically significant difference was shown (P=0.75). Surgeon satisfaction was higher in the KP group (P=0.18) and patient satisfaction was higher in the KM group (P=0.18) but there was no significant difference (P>0.05). Recovery time between groups was Similar and no statistically significant difference was shown (P>0.98). In the KM group at 5 minutes, systolic blood pressure (SBP) was notably greater than the other group (P=0.02) and diastolic blood pressure was notably greater than the KP group (P=0.08).
Conclusion: It can be stated that adding a small dose of ketamine to propofol and midazolam is associated with effective sedation and a similar cardiovascular response during phacoemulsification surgery.
 

Comparison of dexmedetomidine versus midazolam on hemodynamic parameters, bleeding, satisfaction of surgeons and patients who Underwent laminectomy surgery by spinal anesthesia
Behzad Nazemroaya, Mehrdad Masoudifar , Motahare Rajabi Moghadam ,
Volume 79, Issue 5 (8-2021)
Abstract
Background: One of the most empirical subjects particularly in substantial operations for example in surgeries involving the vertebral column, are the implication of sedatives in a manner which would create the least complications such as changes in the hemodynamic parameters. Two such drugs that are widely used in this capacity in clinical settings are midazolam and dexmedetomidine. Hemodynamic stability is particularly important in surgical operations, especially during spinal surgery. One of the ways to prevent hemodynamic changes during surgery is the use of drugs such as midazolam and dexmedetomidine.
Methods: This double-blind randomized clinical trial recruited 105 patients undergoing laminectomy spinal surgery under spinal anesthesia at Al-Zahra Hospital, Isfahan between 21 April 2019 till 1 September 2019. Patients were randomly divided into 3 groups: First was the midazolam group, second the dexmedetomidine group and the third was the control group. Data were presented as mean±standard deviation and percentages. In order for the evaluation of differences to be performed between all groups, an evaluation using the one-way analysis of variance was utilized. Statistical analysis was done by means of the SPSS software version 23 (IBM Corporation, Armonk, New York, USA). The P-value which was accepted as significant was P less than 0.05. (P<0.05)
Results: There differences in age and gender were not statistically significant among the studied groups (p>0.05). Results from the ANOVA test showed that the effects when taking into consideration time (P<0.001) and group (P<0.001) were statistically significant on Mean of Arterial Pressure, Systole Blood Pressure and Diastole Blood Pressure. However, Heart Rate and oxygen saturation (SPO2) were not significantly different inter-group as well as intra-group over time (before, during, and after the operation) (P=0.12).  Furthermore, the mean of the hemorrhage amount and duration of recovery stay had significant differences over time between all three groups (P<0.05).
Conclusion: The incidence of complications during surgery in the dexmedetomidine group was less than the midazolam group. Additionally, the frequency of complications in the subjects given midazolam was higher than the dexmedetomidine group during recovery.

Comparative study of the sedative effect of ketamine-dexmedetomidine (Ketodex)with ketamine-midazolam(Ketomid) in candidates of fibroptic bronchoscopy
Behzad Nazemroaya , Samin Jahanbin,
Volume 80, Issue 8 (11-2022)
Abstract
Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).
Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure.
Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

Investigating the frequency of anterograde amnesia after endoscopy with midazolam as a premedication
Mehrdad Sayadinia, Seyed Mohamad Seyed Mirzayi , Majid Vatankhah, Mehrdad Malekshoar, Tayyebeh Zarei, Bibi Mona Razavi,
Volume 82, Issue 11 (2-2025)
Abstract
Background: Endoscopy is a common medical procedure that often involves the administration of sedative agents to ensure patient comfort and cooperation. Midazolam, a short-acting benzodiazepine, is commonly used as a premedication for its anxiolytic and amnestic properties. Despite its widespread use, there is limited research specifically assessing the occurrence of anterograde amnesia, a potential side effect associated with midazolam administration during endoscopic procedures. Understanding the frequency of this adverse effect is crucial for optimizing patient safety and procedural outcomes.
Methods: In this prospective cohort study After obtaining approval and ethical clearance, patients eligible for endoscopy at Bandar Abbas Shahid Mohammadi Hospital were included in the study. They received 2mg midazolam intravenously before the procedure, followed by propofol for anesthesia maintenance. A memory test involving personal details was conducted before and after the procedure to assess progressive amnesia. Additionally, patients were asked about the procedure 5 minutes before discharge.
Results: 342 endoscopy candidates participated, with an average age of 46.77 years, over half being men. Less than a quarter had a diploma. Average endoscopy time was 2.96 minutes, mostly ASA class 2. Recall scores after midazolam injection and endoscopy were 5.22 and 2.87, respectively. Post-graduate education showed a significant difference in midazolam amnesia. No significant gender difference was observed. Longer endoscopy duration correlated with decreased recall scores. ASA class 2 patients had lower post-endoscopy recall scores than ASA class 1. Recall scores decreased with age, with the highest in the 19-29 age range, a statistically significant finding.
Conclusion: This study In conclusion, this study provided valuable insights into the factors influencing midazolam anterograde amnesia. Key findings include a significant association between higher education levels, particularly post-graduate education, and increased recall scores after midazolam injection. Gender did not show a significant impact on midazolam amnesia, but the duration of endoscopy played a crucial role. Additionally, patients in ASA class 2 exhibited lower recall scores than those in class 1, highlighting the influence of overall health status. Age also emerged as a factor, with the youngest age group showing the highest recall scores after endoscopy. These findings contribute to our understanding of factors affecting midazolam-induced amnesia during endoscopy procedures.

Comparison of the frequency of delirium in patients requiring anesthesia receiving a Presedex and fentanyl regimen with a midazolam and fentanyl regimen in the intensive care unit
Majid Karimifard, Ashkan Sabouri, Khaled Rahmani , Mohammad Azad Majedi, Behzad Ahsan ,
Volume 83, Issue 4 (7-2025)
Abstract
Background: Patients undergoing mechanical ventilation in the intensive care unit (ICU) are at higher risk for delirium. The present study aimed to compare the frequency of delirium in patients requiring anesthesia receiving the Presedex and fentanyl regimen with the midazolam and fentanyl regimen in the intensive care unit (ICU).
Methods: This historical cohort study was conducted on all patients hospitalized in the intensive care unit of Kowsar Hospital in sanandaj from May 2018 to December 2024 as a census with a sample size of 40 people in each group. Delirium and restlessness were assessed based on RASS criteria and the GCS scale was used to assess the level of consciousness of the patients. The data were entered into SPSS 24 software and a significance level of less than 5% was considered.
Results: The average age of the patients in Perdex, fentanyl, midazolam, and fentanyl regimens was 41.52 and 34.05 years, respectively. 53(66.3%) patients were male and the rest were female. The GCS score in the Presdex and Fentanyl group was 14(35%) and the Midazolam and Fentanyl group was 4(10%) with a level of consciousness above 7. The RASS score (5 patients in the Presdex and fentanyl group (12.5%) and the midazolam and fentanyl group (36 patients in the midazolam and fentanyl group (90%) had an anxiety score of zero or higher) was 0. The frequency of delirium based on CAM-ICU criteria in the Presdex and fentanyl group was 27(67.5%) mild delirium and 13(32.5%) moderate delirium, but in the midazolam and fentanyl group, 6(15%) mild delirium, 24(60%) moderate delirium, and 10(25%) severe delirium were present, and this difference was significant in the results of level of consciousness and restlessness and incidence of delirium (P=0.000).
Conclusion: The results showed that the use of Presedex and fentanyl would be more effective in reducing the incidence of delirium, and the use of this drug could be effective.
 
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