Effect of midazolam/fentanyl infusion on haemodynamic and metabolic responses during short surgical procedures

ABSTRACT

Midazolam was used in combination with fentanyl as total intravenous anesthesia for twenty patients undergoing short surgical procedures; fentanyl [1.5 ug/kg] was given intravenously. Three minutes later, midazolam was administered started by bolus dose of 0.3 mg/kg, followed by drip infusion of 0.25 mg/kg/h. Patients were oxygenated by 100% O2 face mask during the procedures. The hemodynamics and metabolic responses [serum cortisol, lactate, pyruvate and blood glucose changes] were followed preoperatively, intra and postoperatively. Although the hemodynamic parameters [systolic, diastolic and mean blood pressure, heart rate and rate pressure product] showed significant changes, they were not of apparent importance. Insignificant increase in blood glucose concentration was seen following incision; but maximum significant concentration was measured after two hours. From induction in the early postoperative period, serum cortisol concentration significantly increased after induction and during surgery then after 24 hours serum cortisol and glucose returned to pre-induction values. Serum lactate significantly decreased until 24 hours after induction, but serum pyruvate increased significantly at skin incision and during operation; but after 24 hours it returned to pre-induction values. In all patients, good operating conditions were produced and patient's acceptance was high. It was concluded that midazolam infusion in combination with fentanyl may be useful technique in short procedures without inhibiting adrenal steroid release or producing cardiorespiratory instability