EFFICACY AND SAFETY OF A NEW PROTOCOL FOR CONTINUOUS-INFUSION OF MIDAZOLAM AND FENTANYL AND ITS EFFECTS ON PATIENT DISTRESS DURING ELECTROPHYSIOLOGICAL STUDIES

Electrophysiological studies are often distressing for patients. We de vised a regime of continuous infusion of midazolam and fentanyl during electrophysiological studies without the presence of a specialist ana esthetist. The effects on key hemodynamic and respiratory variables an d level of sedation were evaluated in detail in the first 775 patients . The safety of this practice was evaluated in 1,344 consecutive patie nts. Doses were calculated according to patients' weight and age. A me an total dose of 26 mg of midazolam and 115 meg of fentanyl were infus ed. Satisfactory sedation was achieved in 97% of patients. The mean du ration of procedure was 188 +/- 90 minutes. Complete amnesia of the pr ocedure was obtained in 87% of patients. Sedation caused clinically in significant changes in respiratory rate, oxygen saturation, end-tidal CO2 and blood pressure. There were no major complications related to s edation. Upper airway obstruction, usually minor, occurred in 42% and some restlessness in 20% of sedated patients. The assistance of a spec ialist anesthetist was required in 0.3% of sedated patients for manage ment of restlessness, hypoventilation, or obstructive sleep apnea. The amount of distress experienced by sedated patients (n = 775) was sign ificantly less compared to a previous series of nonsedated patients (n = 775) undergoing electrophysiological studies (P < 0.001). The degre e of distress experienced by patients during electrophysiological stud ies can be reduced significantly by sedation with intravenous midazola m and fentanyl. Continuous infusion is an efficient, safe, and effecti ve way of administering midazolam and fentanyl.