Mg. Pratila et al., PROPOFOL VERSUS MIDAZOLAM FOR MONITORED SEDATION - A COMPARISON OF INTRAOPERATIVE AND RECOVERY PARAMETERS, Journal of clinical anesthesia, 5(4), 1993, pp. 268-274
Study Objective: To compare intraoperatize and recovery parameters in
Patients who received either propofol infusion (PI), propofol bolus (P
B), or midazolam bolus (MZ) for sedation. Design: Randomized clinical,
study Setting: Medical/surgical patients in a specialized hospital. P
atients: Ninety patients, aged 18 to 85 years, scheduled for central v
enous access for chemotherapy and/or total parenteral nutrition. Inter
ventions: In 30 patients, sedation was induced with MZ 0.02 mg/kg intr
avenously (IV), repeated every 2 to 3 minutes to achieve a sedation le
vel of 3 (eyes closed, responds to verbal stimulus (SL3). Maintenance
was with MZ 0.005 mg/kg IV, repeated as necessary to maintain SL3. In
both propofol groups (30 patients each), induction of sedation was wit
h a bolus of propofol 0.75 to 1.0 mg/kg IV. Maintenance in the PB grou
p was with propofol 0.25 mg/kg IV, repeated as necessary to maintain S
L3. Maintenance in the PI group was with propofol 2 to 4 mg/kg/hr or 3
3 to 66 mug/kg/min to maintain SL3. Measurements and Main Results: Blo
od pressure, heart rate, respiratory rate, oxygen saturation, and seda
tion level were monitored each minute for 5 minutes and then at 5-minu
te intervals during the procedure. A right atrial blood sample was tak
en for pH and partial pressure of carbon dioxide at maximum sedation.
Adequate sedation was achieved in all three groups. The time to reach
SL3 was significantly shorter in the PB group than in the PI and MZ gr
oups (p < 0.05 and p < 0.01, respectively). Cardiovascular and respira
tory parameters were remarkably stable. Immediate recovery, as judged
by spontaneous eye opening, response to commands, and ability to state
date of birth, was significantly shorter in both the PB and PI group,
than in the MZ group (p < 0.0001). Intermediate recovery, as measured
by sedation score at recovery entry, Aldrete score, and time to stand
ing, was slower in the MZ group (p < 0.05 for the MZ group vs. the PB
and PI groups for sedation score and Aldrete score; p < 0.05 for the M
Z group vs. the PI group in time to standing). Psychomotor recovery, j
udged by digit symbol substitution tests, was significantly faster in
the PB and PI groups (p < 0.05 vs. the MZ group). Amnesia, measured by
picture recall, was significantly greater in the MZ group than in the
PI and PB groups (p < 0.05). Mood changes were measured on a visual a
nalog scale. All groups showed improvement. Nausea, headache, dizzines
s, blurred vision, appetite, tension, pain, depression, drowsiness, an
d ability to concentrate were evaluated in the preoperative and postop
erative period. The frequency did not differ significantly between gro
ups due to confounding factors such as postoperative chemotherapy and
premedicant drugs. Conclusion: The PI, PB, and MZ groups all gave exce
llent sedation for patients undergoing surgical procedures with local
anesthesia. Amnesia was greater with midazolam, and recovery was more
rapid with propofol.