ABSTRACT
LEVEL OF EVIDENCE: Level III-case-control study.
ABSTRACT
A 63-year-old man with severe coronary artery disease and occlusion of aortic arch branches presented with dizziness, syncope and unstable angina. He underwent a combined surgical procedure of aorto-bicarotid bypass and off-pump myocardial revascularization. The operation was successful and he had no complications during 11 months of follow-up.
Subject(s)
Aorta, Thoracic/surgery , Aortic Arch Syndromes/surgery , Carotid Artery, Common/surgery , Coronary Artery Bypass, Off-Pump/methods , Coronary Disease/surgery , Anastomosis, Surgical/methods , Aortic Arch Syndromes/complications , Aortic Arch Syndromes/diagnosis , Coronary Angiography , Coronary Disease/complications , Coronary Disease/diagnostic imaging , Follow-Up Studies , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND OBJECTIVE: To compare the perioperative effects of melatonin and midazolam given in premedication, on sedation, orientation, anxiety scores and psychomotor performance. METHODS: Exogenous administration of melatonin not only facilitates the onset of sleep but also improves its quality. A prospective, randomized, double-blind, placebo-controlled study was performed in 66 patients undergoing laparoscopic cholecystectomy. Patients were given melatonin 5 mg, midazolam 15 mg or placebo, 90 min before anaesthesia, sublingually. Sedation, orientation and anxiety were quantified before; 10, 30, 60 and 90 min after premedication; and 15, 30, 60 and 90 min after admission to the recovery room. Neurocognitive performance was evaluated at these times, using the Trail Making A and B and Word Fluency tests. The differences between the groups were analysed by ANOVA. Two-way comparisons were performed by Scheffé analysis. Sedation and amnesia were analysed by the chi2 test. RESULTS: Patients who received premedication with either melatonin or midazolam had a significant increase in sedation and decrease in anxiety before operation compared with controls. After operation, there was no difference in sedation scores of all groups. Whereas, 30, 60 and 90 min after premedication the melatonin and midazolam groups exhibited a significantly poorer performance in Trail Making A and B tests compared with placebo, there were no significant differences among the groups in terms of neuropsychological performance after the operation. Amnesia was notable only in the midazolam group for one preoperative event. CONCLUSION: Melatonin premedication was associated with preoperative anxiolysis and sedation without postoperative impairment of psychomotor performance.
