The effect of midazolam at two plasma concentrations of hemodynamics and sufentanil requirement in coronary artery surgery
- PMID: 8725417
- DOI: 10.1016/s1053-0770(96)80097-8
The effect of midazolam at two plasma concentrations of hemodynamics and sufentanil requirement in coronary artery surgery
Abstract
Objectives: In this study, the hemodynamics and sufentanil requirement were compared at two midazolam target plasma concentrations in patients undergoing coronary artery bypass grafting (CABG).
Design: Prospective, randomized study.
Setting: University hospital, single institution.
Participants: Patients undergoing CABG.
Interventions: Patients were randomly assigned to receive midazolam at a target plasma concentration of 150 ng/mL (group 1; n = 10) or 300 ng/mL (group 2; n = 10). Sufentanil infusion was titrated to maintain hemodynamic stability, defined as mean arterial pressure within 15% of baseline values. All patients received preoperative beta-blocking agents. Arterial blood samples of midazolam and sufentanil were analyzed by high-performance liquid chromatography and radioimmunoassay, respectively.
Measurements and main results: The mean dose of sufentanil (7.5 +/- 1.7 microgram/kg in group 1 v 7.2 +/- 2.5 micrograms/kg in group 2) did not differ. There were no significant differences in hemodynamics between the groups in the period before or after cardiopulmonary bypass (CPB). Before CPB, in two patients in each group, hypertension was controlled with sufentanil only. One patient in group 1 required a vasodilator in addition to sufentanil. No ischemic events occurred before CPB. After CPB, one patient in group 2 required a vasodilator to control hypertension. Two patients in group 2 required treatment with nitroglycerin for myocardial ischemia. Stable plasma concentrations of sufentanil and midazolam were obtained during and after CPB. The midazolam infusion was continued in both groups at a rate of 1.25 micrograms/kg/min during the first 4 postoperative hours. The time to awakening did not differ between the groups (100 +/- 58 minutes in group 1 v 173 +/- 147 minutes in group 2) nor did the plasma concentrations of midazolam (96 +/- 28 ng/mL v 108 +/- 42 ng/mL) at the time of awakening. Intraoperative awareness was not reported.
Conclusion: In patients undergoing CABG, good hemodynamic control with a similar incidence of hemodynamic interventions was observed at midazolam target plasma concentrations of 150 and 300 ng/mL when coadministered with sufentanil. The sufentanil requirement was identical in both groups. This study suggests that a midazolam plasma concentration of 150 ng/mL is sufficient to provide satisfactory hemodynamic control and to avoid intraoperative awareness.
Similar articles
-
A comparison of fentanyl and sufentanil in patients undergoing coronary artery bypass graft surgery.J Cardiothorac Vasc Anesth. 2000 Dec;14(6):652-6. doi: 10.1053/jcan.2000.18307. J Cardiothorac Vasc Anesth. 2000. PMID: 11139103 Clinical Trial.
-
Pharmacokinetic model-driven infusion of sufentanil and midazolam during cardiac surgery: assessment of the prospective predictive accuracy and the quality of anesthesia.J Cardiothorac Vasc Anesth. 2000 Aug;14(4):402-8. doi: 10.1053/jcan.2000.7931. J Cardiothorac Vasc Anesth. 2000. PMID: 10972605
-
Multicenter study of target-controlled infusion of propofol-sufentanil or sufentanil-midazolam for coronary artery bypass graft surgery. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.Anesthesiology. 1996 Sep;85(3):522-35. doi: 10.1097/00000542-199609000-00011. Anesthesiology. 1996. PMID: 8853082 Clinical Trial.
-
Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.J Cardiothorac Vasc Anesth. 1993 Oct;7(5):615-9. doi: 10.1016/1053-0770(93)90325-f. J Cardiothorac Vasc Anesth. 1993. PMID: 8268446 Review.
-
Anaesthesia techniques for midazolam and flumazenil--an overview.Acta Anaesthesiol Scand Suppl. 1990;92:84-9; discussion 107. doi: 10.1111/j.1399-6576.1990.tb03192.x. Acta Anaesthesiol Scand Suppl. 1990. PMID: 2109476 Review.
Cited by
-
Anaesthetic interventions for prevention of awareness during surgery.Cochrane Database Syst Rev. 2016 Oct 18;10(10):CD007272. doi: 10.1002/14651858.CD007272.pub2. Cochrane Database Syst Rev. 2016. PMID: 27755648 Free PMC article. Review.
-
Randomized exposure-controlled trials; impact of randomization and analysis strategies.Br J Clin Pharmacol. 2007 Sep;64(3):266-77. doi: 10.1111/j.1365-2125.2007.02887.x. Epub 2007 Apr 10. Br J Clin Pharmacol. 2007. PMID: 17425629 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical