Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL

comparison between midazolam co-induction and propofol predosing for the induction of anaesthesia in the elderly

Co-induction is the administration of a small dose of a sedative or anaesthetic agent prior to induction of anaesthesia, the aim being to reduce the dose of induction agent required. The aim of this study was to compare the efficacy, safety and cardiovascular stability of low dose midazolam co-induction and propofol pre-dosing using propofol for induction of anaesthesia in elderly patients. In a randomized, placebo-controlled trial, we enrolled 60 patients aged 60 years or more with ASA between I and III attending for opthalmic surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg[-1], propofol 0.25 mg.kg[-1], or normal saline 2 ml [placebo] 2 min prior to induction of anaesthesia using propofol 1% infusion at 5 ml/min. The propofol dose requirements for induction were recorded for two end-points [loss of verbal contact [LOVC] and insertion of an oropharyngeal airway]. cardiovascular parameters, respiratory rate and oxygen saturation were recorded at 1-min intervals for each patient until induction was complete. Intraocular pressure was recorded before and after induction. The time and the dose of propofol required to induce LOVC, jaw relaxation [JR] and insertion of Guedel oropharyngeal airway showed a statistically significant decrease in both the midazolam and the propofol groups, when compared to the saline group, [P<0.05]. There was a statistically significant decrease in the intraocular pressure after induction in the saline and the propofol groups, [P<0.05]. The haemodynamic parameters [bloodpressure [Systolic and diastolic] and heart rate] and the respiratory rate of patients in all groups showed a statistically significant decrease [P<0.05] from baseline reading however the comparison between the groups showed that decrease was non significant. The oxygen saturation of patients in all groups showed a significant increase from preoperative baseline reading [P<0.05]. Midazolam co-induction and propofol predosing reduce the dose of propofol [33.5%] and [10%] respectively and the time required for induction of anesthesia by propofol infusion in the elderly with no improvement of cardiovascular stability

effect of remifentanil-midazolam on electrophysiological properties of normal conduction system and accessory pathways in wolff-parkinson-white syndrome in cardiac catheterization laboratories

The effects of remifentanil midazolam sedation upon the electrophysiologic [EP] properties of normal atrioventricular [A-V] and accessory pathway [AP] conduction were studied in twenty patients with Wolff-Parkinson-White [WPW] syndrome during accessory pathway ablation in cardiac catheterization laboratories [CCL] The presence of an AP was confirmed by baseline EP studies. Sedation was induced with remifentanil [0.5mcg/kg] over 30-60 second and midazolam [0.1 mg /kg] and maintained with remifentanil infusion [0.025-0.05mcg/kg/min]. A baseline EP study was performed which consisted of effective refractory period [ERP] and shortest cycle length [SCC] measurement during antegrade conduction in the normal A-V pathway arid AP, as well as during retrograde conduction in the AP. Comparison with baseline EP studies indicated that the administration of remifentanil-midazolam sedation had no effect upon conduction or ERP in either pathways. Haemodynamic stability and no significant blood gases changes oct urred throughout the ablation procedure with no development of dysrrhythmia. We conclude that a combination of remifentanil-midazolarn is suitable for sedation in patients undergoing ablative procedures for accessory pathways in cardiac catheterization laboratories [CCL]

effect of midazolam premedication on hypnotic dose of propofol and recovery criteria in outpatient surgery

We investigated the effect of two small doses of midazolam on the hypnotic dose of propofol and recovery criteria in ambulatory gynecologic laparoscopic surgery. Sixty adult female patients, aging 18-40 years. ASA status I and II, scheduled for elective laparoscopic surgery were included. They were divided into three groups, in a random and double-blind fashion according to the drug given for premedication: group "A" given 2 ml of normal saline, group "B" given 20 micro g/kg midazolam and group "C" given 40 micro g/kg midazolam. All drugs were given I.V. 15 minutes before induction of general anesthesia using standardized technique. Dose of propofol and the time needed to reach complete hypnosis were recorded. Recovery times from end of surgery till start of spontaneous respiration, extubation, spontaneous eye opening, obeying commands, ambulation and discharge from post-anesthesia care unit [PACU] and ambulatory surgical unit [ASU] were also recorded by blinded observer. We found that no significant difference was recorded between patients in groups "A" and "B" in all data [P < 0.05]. Group "C" patients showed significantly lower dose of propofol required for induction of general anesthesia and significantly shorter time required to reach complete hypnosis [P < 0.05]. Moreover, significantly longer time was needed to start spontaneous respiration, extubation and eye opening [P < 0.05], while no significant difference between the three groups in other recovery criteria. So, 40 micro g/kg midazolam given for premedication in outpatient surgery markedly decreases hypnotic dose of propofol required for induction of general anesthesia with minimal effect on recovery criteria and overall hospital discharge time

Haemodynamic profile of isoflurane versus total intravenous anaesthsia in patients submitted for closed mitral commissurotomy

This study was conducted on 16 patients submitted to closed mitral commissurotomy surgery. They were randomly classified into two groups eight patients each. The first group recieved thiopentone-for induction and isoflourane-vecronium for maintenance The second group received kjtamine-midazolam for induction and then followed by continuous infusion according to a pharmacokinetics based multistepped decreasing regimen. Arterial cannulation and pulmonary artrey catheter were fixed to measure the haemodynamic variables at 5 time points before and during surgery. Data are collected and analysed statistically to compare both groups and record changes during the course of surgery inside each group. The results showed non significant changes between the two groups regarding the haemodynamic parameters recorded, but the systemic vascular resistance [SVR] was significantly increased in the isoflourane group at post-commissurotomy time point. In conclusion, TIVA with ketamine-midazolam can provide a pattern of haemodynamic stability during mitral valve stenosis surgery comparable to that of isoflurane. Concomitant ad-minsteration of midazolam to ketamine according to the regemin used in this study almost neutralized the cardiovascular effects of ketamine