Humans ; Benzodiazepines ; Hypnotics and Sedatives/therapeutic use* ; Intensive Care Units ; Midazolam

OBJECTIVETo compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU).

METHODSEighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events.

RESULTSSatisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (P<0.05). Both groups showed decreases in heart rate (HR), mean arterial pressure (MAP), and spontaneous breathing frequency (RRs) after treatment. However, the remifentanil+midazolam group had significantly greater decreases in HR at 3-24 hours after treatment and MAP and RRs at 3-12 hours after treatment than the midazolam group (P<0.05). Compared with the midazolam group, the remifentanil+midazolam group had significantly higher ventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (P<0.05). The remifentanil+midazolam group had significantly shorter time to awake, extubation time, duration of mechanical ventilation, and length of PICU stay than the midazolam group (P<0.05). There were no significant differences in PICU cost, incidence of adverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (P<0.05).

CONCLUSIONSFor children with mechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.

Analgesics ; therapeutic use ; Blood Glucose ; analysis ; Female ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Infant ; Intensive Care Units, Pediatric ; Male ; Midazolam ; therapeutic use ; Piperidines ; therapeutic use ; Respiration, Artificial

BACKGROUNDAnxiety and fear frequently causes an aversion to applying a face mask and increases difficulty during pediatric induction. There is at present little study of this problem. Therefore, the aim of this study was to investigate the effect of the combination of mask preconditioning and midazolam pretreatment on mask acceptance during pediatric induction and on postoperative mask fear.

METHODSOne hundred and sixty children were randomly assigned into four groups: the mask preconditioning group (MaG), the midazolam pretreatment group (MiG), the mask/midazolam combination group (Ma/MiG), and the saline group (SaG). The Modified Yale Preoperative Anxiety Scale (m-YPAS) was employed to assess the anxiety in the operation room (OR). A Mask Acceptance Score (MAS) was measured during inhalational induction and the incidence of mask fear (MAS ≤ 2) was evaluated postoperatively.

RESULTSThe MaG and Ma/MiG groups had the highest mask acceptance scores but there were no differences between these two groups (P < 0.05). The average anxiety level of children entering the OR was much lower in the MaG and Ma/MiG groups than in the SaG group (P < 0.05). During induction, the anxiety level increased in the SaG and MaG groups but decreased in the MiG and Ma/MiG groups (P < 0.05). At the postoperative third day, the incidence of mask fears was as high as 23% in the SaG group, 15% in the MiG group, but only 2.5% in the MaG and Ma/MiG groups.

CONCLUSIONSThe single use of mask preconditioning has a better influence than midazolam for increasing mask acceptance during inhalational induction and reducing postoperative mask fear, reducing the anxiety level during induction, improving induction compliance and shortening the total mask time. A mask preconditioning and midazolam combination did not increase mask acceptance during inhalational induction, reduce mask fears postoperatively, improve induction compliance, nor shorten the total mask time. But it can better reduce the anxiety level during induction.

Anxiety ; prevention & control ; Child ; Child, Preschool ; Fear ; drug effects ; Female ; Humans ; Male ; Masks ; Midazolam ; therapeutic use

OBJECTIVETo compare the efficacy of midazolam and diazepam for treatment of acute seizures in children.

METHODSOne hundred and twenty children with acute seizures were randomly divided into two groups: midazolam (0.1-0.3 mg/kg) and diazepam treatment (0.3-0.5 mg/kg) (n=60 each). In cases with seizure recurrence or statural convulsivus, a maintenance dose of midazolam (1-8 mg/kg per hour) and a maintenance dose of diazepam (0.5-1 mg/kg per hour) or along with phenobarbital sodium were given in the midazolam and diazepam treatment groups, respectively. The therapeutic effects were compared between the two groups.

RESULTSThe seizures were relieved in all cases from the two groups 10 minutes after administration of midazolam or diazepam. There were no significant differences in the average time of seizure control between the two groups. Five children in the midazolam group had seizure recurrence or statural convulsivus after 10 minutes compared with 13 children in the diazepan group (P<0.05). The time of seizure control averaged 40+/-32 minutes in the midazolam group compared with 69+/-24 minutes in the diazepam group after maintenance treatment (P<0.05). No midazolam and diazepam treatment related adverse events were observed.

CONCLUSIONSMidazolam is safe and effective in the treatment of acute seizures in children. Midazolam appears to be a better option in the treatment of recurrent seizures or statural convulsivus than diazepam.

Acute Disease ; Anticonvulsants ; therapeutic use ; Child ; Child, Preschool ; Diazepam ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Midazolam ; adverse effects ; therapeutic use ; Seizures ; drug therapy

OBJECTIVETo compare the sedative effects of different doses of dexmedetomidine (DEX) and midazolam (MDZ) in dental implant surgery:

METHODSSixty patients undergoing dental implantation were selected and divided randomly into six groups (10 in each group). In group 1 (G1), a highdose of MDZ alone was administered intravenously. In group 2 (G2), a relatively low dose of MDZ and DEX was administered intravenously. In group 3 (G3), a highdose of MDZ and DEX was administered intravenously. In group 4 (G4), a lowdose of MDZ and a highdose of DEX were administered. In group 5(G5), a highdose of MDZ and a low dose of DEX were administered. In group 6 (G6), a highdose of DEX alone was administered intravenously. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation values were measured. Sedation was assessed by determining the Ramsay sedation scores(RSS) during infiltration anesthesia (T1), incision (T2), cutting (T3), and suturing (T4). Before discharging from the hospital, patients were asked if they remembered the T1 to T4 procedures. The visual analogue scale (VAS) and the degree of patient satisfaction were assessed at the same time.

RESULTSIn T1 to T4, the systolic blood pressure (SBP) in G3 was the lowest and was significantly different from that in G1 and G2 (P < 0.05). In G1, the SBP was higher than that in G6 at the T3 and T4 points (P < 0.05). HR was below the preoperative (P < 0.05) in the G3 only. RSS was the lowest in G1 during the whole procedure. In G2, most patients obtained scores of 2-3. In G3, sedation was deeper, had more cases ofup to 5. In G4, most patients obtained scores of 3-4. In G5, some patients had a score of up to 5. The RSS in G6 was lower than that in G3 and G4 or G5 in T1 to T2, closer to G4 in T2. An evaluation of the VAS and the degree of patient satisfaction did not show any differences among the groups.

CONCLUSIONThe combination of DEX and MDZ is superior to a single intravenous injection. Low-dose MDZ combined with high-dose DEX achieved the highest quality of sedation in this study.

Anesthesia ; Blood Pressure ; Dental Care ; Dental Implants ; Dexmedetomidine ; therapeutic use ; Heart Rate ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Midazolam ; therapeutic use ; Pain Measurement ; Patient Satisfaction ; Prospective Studies

OBJECTIVETo compare the safety and efficacy of midazolam and estazolam in hypertensive patients with chronic insomnia.

METHODSIn this multicentre, open labeled, randomized clinical trial, 217 adult (18 - 75 years) hypertensive patients (BP range 140 mm Hg or= 3 times/week for more than 1 month) were randomly divided into midazolam (7.5 - 15 mg before sleep, n = 113) or estazolam group (1 - 2 mg before sleep, n = 104). Patients took medication according to own need. Sleep diary should be completed within 15 minutes after getting up next morning. Follow-up analysis was performed in patients completed 8 sleep diaries or received midazolam or estazolam for 1 month. Patients' sleep diaries were evaluated, blood pressure and heart rate before and after therapy were measured and adverse events were recorded.

RESULTS(1) Blood pressure was equipotent reduced after both treatments (-11.8/7.3 mm Hg for midazolam group, and -9.1/5.6 mm Hg for estazolam group, all P < 0.05 vs. before treatment). (2) The total sleep score was also significantly decreased in both groups after medication (P < 0.01) and midazolam was significantly superior to estazolam in shortening sleep latency, reducing awakening frequency, improving objective sleep evaluation and decreasing daytime sleepiness, but there were no differences in dream frequency and total sleep time. (3) The adverse reactions such as dizziness, headache and nausea was similar in midazolam (3%) and estazolam group (7%, P > 0.05).

CONCLUSIONSIt is safe to take midazolam or estazolam for hypertensive patients with chronic insomnia and both drugs reduced blood pressure. Midazolam is superior to estazolam in shortening sleep latency, reducing awakening frequency, improving objective sleep evaluation and decreasing daytime sleepiness.

Aged ; Estazolam ; therapeutic use ; Female ; Humans ; Hypertension ; complications ; Hypnotics and Sedatives ; therapeutic use ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; drug therapy ; etiology

OBJECTIVE: To observe the clinical effect of dexmedetomidine on patients during the extubation in general anesthesia.
 METHODS: A total of 90 patients scheduled for general anesthesia were divided into 3 groups (n=30): A dexmedetomidine group (DEX group), a midazolam group (MID group), and a control group(C group). Anesthesia drugs were stopped 10 minutes before the end of the operation. 
At the same time, the patients in the DEX group were given dexmedetomidine at the rate of 
1 g/(kg.h) for 10 min by vein first, which was continuously pumped at the rate of 0.3 g/(kg.h) for 20 min after the operation. The patients in the MID group were given midazolamin at 0.5 mg/kg for 60 s by vein first, which was continuously pumped at the rate of the 0.04 mg/(kg.h) for 20 min after the operation. The patients in the C group were not given any drug. Awakening time and extubation time after the operation were recorded. Ramsay scores, heart rate, mean arterial blood pressure, respiratory rate, and SpO₂were recorded at time of extubation, 10 min or 1 h after extubation. Chills, nausea, vomiting and other side effects after the operation were recorded.
 RESULTS: Awakening and extubation time were not affected in the DEX group, while delayed recovery occurred in the MID group (P<0.05). Compared with the C group, patients in the DEX and MID groups gained better sedative effect, with 2-4 Ramsay scores (P<0.05). The blood pressure and heart rate were steady in the DEX and MID groups, while inhibition of respiration appeared in the MID group.
 CONCLUSION Dexmedetomidine can provide an effective sedation for the patients without affecting the awakening and extubation time. The hemodynamics could be stably maintained by using dexmedetomidine in patients during the extubation in general anesthesia.
Airway Extubation ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Dexmedetomidine ; therapeutic use ; Heart Rate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Midazolam ; therapeutic use

BACKGROUNDThe management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China.

METHODSA multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016. The questionnaire focused on the assessment and management of PAD by the clinicians in ICUs. The practice of PAD was compared among the four regions of China (North, Southeast, Northwest, and Southwest). The data were expressed as percentage and frequency. The Chi-square test, Fisher's exact test, and line-row Chi-square test were used.

RESULTSOf the 1011 valid questionnaire forms, the response rate was 80.37%. The clinicians came from 704 hospitals across 158 cities of China. The rate of PAD assessment was 75.77%, 90.21%, and 66.77%, respectively. The rates of PAD scores were 45.8%, 68.94%, and 34.03%, respectively. The visual analog scale, Richmond agitation-sedation scale, and confusion assessment method for the ICU were the first choices of scales for PAD assessment. Fentanyl, midazolam, and dexmedetomidine were the first choices of agents for analgesic, sedation, and delirium treatment. While choosing analgesics and sedatives, the clinicians put the pharmacological characteristics of drugs in the first place (66.07% and 76.36%). Daily interruption for sedation was carried out by 67.26% clinicians. Most of the clinicians (87.24%) used analgesics while using sedatives. Of the 738 (73%) clinicians titrating the sedatives on the basis of the proposed target sedation level, 268 (26.61%) clinicians just depended on their clinical experience. Totally, 519 (51.34%) clinicians never used other nondrug strategies for PAD. The working time of clinicians was an important factor in the management of analgesia and sedation rather than their titles and educational background. The ratios of pain score and sedation score in the Southwest China were the highest and the North China were the lowest. The ratios of delirium assessment and score were the same in the four regions of China. Moreover, the first choices of scales for PAD in the four regions were the same. However, the top three choices of agents in PAD treatment in the four regions were not the same.

CONCLUSIONSThe practice of PAD in China follows the international guidelines; however, the pain assessment should be improved. The PAD practice is a little different across the four regions of China; however, the trend is consistent.

TRIAL REGISTRATIONThe study is registered at http://www.clinicaltrials.gov (No. ChiCTR-OOC-16009014, www.chictr. org.cn/index.aspx.).

Delirium ; drug therapy ; Dexmedetomidine ; therapeutic use ; Fentanyl ; therapeutic use ; Haloperidol ; therapeutic use ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Intensive Care Units ; statistics & numerical data ; Midazolam ; therapeutic use ; Pain ; drug therapy ; Pain Management ; methods ; Pain Measurement ; methods ; Surveys and Questionnaires

BACKGROUNDWavelet index (WLI) is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index (BIS) in patients regain of consciousness (ROC) in the absence of frontalis electromyographic (EMG) interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery.

METHODSTwelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator's hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness (LOC1). Tunstall's isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation, endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness (ROC1) and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness (LOC2). After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness (ROC2).

RESULTSThe BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance (P < 0.05). Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances (P < 0.05) between ROC1 and LOC1.

CONCLUSIONSThis study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.

Adolescent ; Adult ; Anesthesia, Intravenous ; methods ; Anesthetics, Intravenous ; therapeutic use ; Consciousness ; drug effects ; Female ; Humans ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Monitoring, Intraoperative ; Piperidines ; therapeutic use ; Propofol ; therapeutic use ; Surgery, Oral ; Young Adult

Although several studies examined factors that influence conscious sedation, investigation was limited into the gender and age. The aim of this prospective study is to identify the clinical variables of successful conscious sedation during gastrointestinal endoscopy. A total of 300 subjects who underwent gastrointestinal endoscopy were enrolled in a prospective fashion. They completed a questionnaire to assess height, weight, drinking, smoking, education level, recent medication, past medical history, previous experience of conscious sedation, preprocedural anxiety, and apprehension about the procedure. Efficacy of sedation and amnesia were evaluated by the subject and the endoscopist. Amnesic and sedative effects were proportionally related with age (p<0.0001). Preprocedural anxiety level was higher in women (p=0.0062), younger subjects (p=0.035), slender subjects (p=0.041), and in those without previous experience of conscious sedation (p=0.0034). This anxiety level was also related to increased pain (p=0.0026) and alertness (p=0.0003) during the procedure. Lower dose of midazolam is needed for sedation in older subjects. Subjects with a high level of preprocedural anxiety such as women, younger subjects, slender subjects, and those without previous experience of conscious sedation should be sedated with great caution because generally, they complain of much more severe pain and alertness during the procedure.
Age Factors ; Anesthetics, Intravenous/therapeutic use ; Body Weight ; *Conscious Sedation ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Male ; Midazolam/therapeutic use ; Pain/drug therapy ; Prospective Studies ; Questionnaires ; Treatment Outcome