Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points

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Serval ID
serval:BIB_82813762066F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Midazolam premedication and thiopental induction of anaesthesia: interactions at multiple end-points
Journal
British Journal of Anaesthesia
Author(s)
Wilder-Smith  O. H., Ravussin  P. A., Decosterd  L. A., Despland  P. A., Bissonnette  B.
ISSN
0007-0912 (Print)
Publication state
Published
Issued date
10/1999
Volume
83
Number
4
Pages
590-5
Language
english
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Oct
Abstract
We have studied the effects of midazolam premedication on multiple anaesthetic end-points (hypnotic, loss of verbal contact (LVC); motor, dropping an infusion flex or bag (DF); analgesic, loss of reaction to painful stimulation (LRP); and EEG, attainment of burst suppression (BUR)) during induction by slow thiopental infusion at a rate of 55 mg kg-1 h-1. Patients received midazolam 0.05 mg kg-1 i.v. (group TM, n = 12) or no midazolam (group T0, n = 13). ED50 and ED95 values and group medians for times and doses at the end-points were measured. Midazolam premedication reduced significantly thiopental ED50 and ED95 values at all end-points (exception for ED95 for BUR). Potentiation was greatest for the motor end-point (dropping the infusion bag (DF)) (ED95 +52%, ED50 +23%, median +39%), and smallest for painful stimulation (LRP) (median +18%; ED50 +13%). For LRP and DF, premedication was associated with significant, non-parallel increases in the slope of the thiopental dose-response curves, resulting in marked potency ratio changes from ED50 to ED95 (LRP +31%, DF +29%). There were no such increases for LVC or BUR. The interaction between midazolam and thiopental varied with the anaesthetic end-point and may also depend on the dose of thiopental. Our data suggest that the mechanism of interaction between midazolam premedication and thiopental was different for motor effects or analgesia (DF, LRP) compared with hypnotic effects or cortical depression (LVC, BUR), in agreement with the different central nervous system substrates underlying these distinct anaesthetic end-points.
Keywords
Adult Aged Anesthetics, Intravenous/*pharmacology Anti-Anxiety Agents/*pharmacology Blood Pressure/drug effects Consciousness/drug effects Dose-Response Relationship, Drug Drug Interactions Female Heart Rate/drug effects Humans Male Midazolam/*pharmacology Middle Aged *Preanesthetic Medication Prospective Studies Single-Blind Method Thiopental/*pharmacology
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 11:51
Last modification date
01/10/2019 7:18
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