Benzodiazepines ; blood ; Case-Control Studies ; Chromatography, Gas ; Humans

The effects of flumazenil, a benzodiazepine antagonist were evaluated in a clinical study in which midazolam (0.1 mg/kg) was used as a sedative agent during the spinal anesthesia. Sixty patient were divided into two groups as group F (n=30) and group S (n=30). Flumazenil 0.3 mg (3 mL) in group F and saline 3 mL in group S were administered at the end of surgery. Blood pressure, pulse rate, respiratory rate and oxygen saturation (SaO2) were checked just before and at, 5, 15, 30, 60 and 120 minutes after the administration of flumazenil or saline. Also we evaluated the level of conciousness and orientation in time and space. The results were as follows; 1) Changes in blood pressure, pulse rate and respiratory rate were not different between two groups, exeept SaO2 was which increased significantly in the flumazenil group. 2) The flumazenil group revealed improved level of consciousness and orientation in time and space which began 5 minutes after flumazenil and was maintained 30 minutes thereafter. 3) We could not observe the any side effects of flumazenil.
Anesthesia, Spinal* ; Benzodiazepines ; Blood Pressure ; Consciousness ; Flumazenil* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Respiratory Rate

Midazolam is a new water soluble benzodiazepine which used to induce anesthesia. The drug possesses properties similar to those of benzodiazepines(sedative, anxiolytic, anticonvulsant, muscle-relaxant) and has low toxicity compared with thiopental which is world-wide used for induction agent. Midazolam is characterized by slow onset of action, more gradual effects on circulation, low frequency of thrombophlebitis and greater degree of antegrade amnesia. Because of these characteristics midazolam is used as an alternative induction agent. As an induction agent, in order to evaluate the properties of midazolam compared with thiopental, 60 patients were divided into 2 groups. Group I, thiopental 5 mg/kg induction group; Group II, midazolam 0.15mg/kg induction group. Systolic and diastolic blood pressure, pulse rate, induction time and recovery time were measured in each group. Frequency of the throm bophlebitis, retrograde and antegrade amnesia were evaluated. In group I, systolic blood pressure decreased significantly and pulse rate increased signifi-cantly. In group II, diastolic pressure decreased significantly and pulse rate increased signifi-cantly. Induction time and recovery time were delayed significantly in group II than group I. In group II, frequency of the thrombophlebitis was lower and antegrade amnesia was greater than group I. Retrograde amnesia did not occured in both groups. On the basis of these data, midazolam used for induction maintains hemodynamic stability, induces anesthesia smoothly, produces low frequency of the thrombophlebitis and high frequency of antegrade amnesia. Therefore it is concluded that midazolam is safe and effective induction agent and may offers an advantage over thiopental in situations where hemodynamic stability is crucial.
Amnesia ; Amnesia, Retrograde ; Anesthesia ; Benzodiazepines ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Midazolam* ; Thiopental* ; Thrombophlebitis

BACKGROUND: Midazolam, a water soluble benzodiazepine, is a good sedative, hypnotic, anxiolytic, and anticonvulsant drug. During stressful condition such as an operation, sympathetic tone increases and cardiovascular variables are unstable. This study evaluated the effects of midazolam for cardiovascular stability in elderly patients during anxiety and stress conditions. Method: Thirty patients (aged 61-93 yrs and in ASA 1, 2, and 3), who were scheduled for lower extremity surgery and showed elevated blood pressure before anesthesia, were divided into two groups. Group 1 (n = 15) has taken antihypertensive medication and group 2 (n = 15) had no hypertension history. Blood pressure and pulse of all patients were checked at 8 AM on operation day, arrival in operation room, 5, 10, 15 min. before anesthesia and every 5 min after anesthesia. Patients were given intravenous midazolam 0.01 mg/kg every 5 min until blood pressure lowered to 140/90 mmHg or spontaneous eye closing. RESULTS: The midazolam doses were 1.7 mg in group 1, 1.2 mg in group 2, and the total dose of midazolam for elderly patient was 1.5 mg (0.03 mg/kg). The sedation level was between the Ramsey scale 3-4. Age is a major determinant in deciding the dose of the drug. Blood pressure at arrival in the operation room was significantly elevated, but, 15 min after the midazolam injection, blood pressure was decreased to blood pressure level at 8 AM of the operation day. Conclusion: The total dose of midazolam for the elderly is nearly 1/3-1/4 of the recommened dose for healthy young adults. Small doses of midazolam in elderly patients were good for anxiolysis and cardiovascular stability.
Aged* ; Anesthesia ; Anxiety* ; Benzodiazepines ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension ; Lower Extremity ; Midazolam* ; Young Adult

OBJECTIVE: To develop a method for determination of clozapine, olanzapine and mirtazapine in human plasma by liquid chromatography-tandem mass spectrometry(LC-MS/MS). METHODS: Clozapine, olanzapine and mirtazapine were extracted from plasma samples by using diethyl ether and separated by Agilent Zorbax SB-C18 column(2.1 mm x 150 mm, 5 microm). Electrospray ionization source was applied, positive ion mode was used to detect and multiple reaction monitoring mode was used to quantify clozapine, olanzapine and mirtazapine. Carbamazepine was the internal standard. RESULTS: The detection limits of clozapine, olanzapine and mirtazapine were within 0.41-0.92 ng/mL. The calibration curve in the concentration range of 10.0-2000.0 ng/mL showed a good linear distribution (r > or = 0.992 4). The average extraction recoveries were within 65.7%-94.2%. Intra-day RSD and inter-day RSD were less than 6% (n = 5). CONCLUSION This method seems to be quite specific, sensitive and accurate, and can be used to detect clozapine, olanzapine and mirtazapine in forensic and clinical analytic toxicology.
Benzodiazepines/blood* ; Chromatography, Liquid/methods* ; Clozapine/blood* ; Forensic Toxicology ; Humans ; Mianserin/blood* ; Mirtazapine ; Olanzapine ; Tandem Mass Spectrometry/methods*

Midazolam maleate, a water solule benzodiazepine unlike diazepam, was synthetized by Walser and Fryer in 1975. In order to evaluate the effectiveness as an induction agent for general anesthesia, 22 elective surgical patients belonging to ASA classification 1 and 2 were selected. And ten patients(male 7, female 3, average 33.5 years old) were induced with midazolam maleate 0.2mg/kg and twelve patients (male7, female 5, averaged 32.5 years old) with diazepam 0.4mg/kg. The results were summarized as follows. 1) Anesthesia was induced in all of midazolam group by one intravenous injection, but only 6 patients of diazepam group could induced by one injection and the other 6 patients needed 2 or more injections. 2) The changes of blood pressure and pulse rate after induction and intubation were almost similar in the two groups, but greater individual variation was seen in diazepam group. 3) A buring sensation following intravenous injection was noted in 11 cases of diazepam group, but none in midazolam group and no phlebitis in either group. From the above resutls, diazepam and midazolam are almost similar in nature but midazolam is definitely effective as an induction agent and has less isde effects. Therefore midazolam maleate is regraded as a more effective agent than diazepam as an induction for general anesthesia.
Anesthesia* ; Anesthesia, General ; Benzodiazepines ; Blood Pressure ; Classification ; Diazepam* ; Female ; Heart Rate ; Humans ; Injections, Intravenous ; Intubation ; Midazolam* ; Phlebitis ; Sensation

Midazolam, a water soluble benzodiazepine, was compared with diazepam as the changes of eardiopulmonary function during sedation under the spinal anesthesia in elderly patients. The results were as follows; I) Cardiovascular effect. At the conclusion after diazepam 0.05 mg/kg(Group D) or midazolam 0.02 mg/kg(Group M) injection, systolic, diastolic pressure and heart rate were significantly decreased(P<0.05) in the both group from 3 min to 30 min, but maintained within normal range. However, it is not significant difference that each group. 2) Respiratory effect. SaO decreased significantly at 3 min. in M-group after midazolam injection but there was not significant difference from change in D-group. Respiratory rate, pH and PaCO2 were not significantly changed between D-group and M-group. However, PaO2 was significantly decreased(p<0.05) within normal range at 3 min. in M-group after midazolam IV and significant difference between both groups. From the above results, We have concluded that IV administration of small dose of diazepam or midaaolam during spinal anesthesia had a little changed in cardiopulmonary function. However, sedative effect was efficient.
Aged* ; Anesthesia, Spinal* ; Benzodiazepines* ; Blood Pressure ; Diazepam ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypnotics and Sedatives ; Midazolam ; Reference Values ; Respiratory Rate

The actions and side effcts of the benzodiazepine antagonist flumazenil were evaluated in a clinical study in which midazolam was used as an anesthetir induction agent. Anesthesia was maintained with nitrous oxide-oxygen-fentanyl. Sixty-five adult surgical patients received either 0.3 mg (3 ml) of flumazenil (33 cases) or 3 ml of saline (32 cases) at the conclusion of surgery. Blood pressure, pulse rate, and respiratory rate were checked before premedication, just before, 5 minutes, 30 minutes, and 120 minutes after the administration flumazenil or saline. Also level of consciouseness, orientation in time and space, and cooperativeness along with end tidal carbon dioxide and hemoglobin oxygen saturation were evaluated. Various larboratory parameters were checked before premedication and 24 hours after operation. The results were as follows: 1) The flumazenil group revealed improved level of consciousness, orientation in time and space, and cooperativeness which began just after the administration, and was maintained 30 minutes thereafter. 2) There was no difference in the changes of laboratory parameters between the two groups. 3) The changes of blood pressure, pulse rate, respiratory rate, and SaO2 showed no difference between those two groups. 4) The end tidal concentrations of carbon dioxide after drug administration were significantly lower in the flumazenil group than those of the saline group. 5) Tolerance to flumazenil (0.3 mg) was good without any side effect.
Adult ; Anesthesia* ; Benzodiazepines ; Blood Pressure ; Carbon Dioxide ; Consciousness ; Flumazenil* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication ; Respiratory Rate

The present study atternpted. to expiore the new benzodiazepine, midazolam, which is water-soluble, shorter-acting, more potent, and less irritating to inject than diazepam, and which has been used as premedication before induction of anesthesia in various elective surgeries. Forty patients (aged 20 to 50 and in ASA class I or II ) about to undergo simple elective surgery under general anesthesia entered the study. The patients were divided into the study group (n=20) that recieved 0.07 mg/Kg i.m midazolan premedication and the control group (n= 20) that recieved normal saline as sham premedication. The changes in the values of various hemodynamic parameters, i.e., heart rate and systolic, diastolic, mean arterial pressures, were monitored first before tracheal intubation, then at the time of intubation and 5, 10 and 30 minutes after intubation. The concentrations of plasma catecholamines i.e., epinephrine and norepinephrine, were measured before intubation and 5, 30 minutes after intubation. Systolic pressure and plasma epinephrine concentration before induction was significantly low in the study compared with the controls. At the time of intubation, sytolic, diastolic & mean arterial pressures were significantly low in the study group compared with the controls. Heart rates measured at 10 and 30 minutes postintubation were significantly low at 30 minutes postintubation in the study group compared with the controls as was plasma epinephrine levels at each instance of its measurement. In conclusion, midazolam-premedicated patients appear to maintain stable hemodynamies and plasma catecholamine levels. Our findings support that midazolam premedication effectively reduces stress response during induction period making it suitable induction for elective surgery.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Benzodiazepines ; Blood Pressure ; Catecholamines ; Diazepam ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Midazolam* ; Norepinephrine ; Plasma* ; Premedication*

Animals ; Benzodiazepines ; pharmacology ; Ducks ; physiology ; Growth Hormone ; blood ; Insulin-Like Growth Factor I ; metabolism ; Serum ; metabolism ; Weight Gain ; drug effects