Midazolam co-induction in the elderly

ABSTRACT

In elderly patients I have compared the effects of midazolam co induction and propofol predosing on the induction dose requirements of propofol. In a randomized, double blind controlled trial, I have enrolled 150 patients over 65 years of age scheduled for urological endoscopic surgery and randomly assigned them into 3 groups 50 in each group to receive either midazolam 0.05 mg/kg, propofol 0.2 mg/kg, or normal saline [placebo] 2 min. before induction of anesthesia with propofol 1% infusion at 5 ml/min, the dose of propofol was calculated from the start of infusion till the loss of verbal contact with the patient and the ability to smoothly insert an oropharybgeal airway. Cardiovascular parameters were recorded at 1 min interval until induction was complete. the primary outcome of this study is the reduction of the induction dose of propofol by 20% and a secondary outcome was the reduction of the induction time, the relative risk of the primary outcome was found 0.89 [at confidence interval 95%], the absolute risk reduction 0.82. The midazolam group showed a significant reduction in the propofol dose requirements for induction [p=0.05] compared to the placebo group. The propofol group did not show significant dose reduction compared to the placebo group. Cardiovascular parameters were not significantly different in the 3 groups in terms of stability. I conclude that midazolam co-induction reduces the induction dose of propofol in elderly patients