Low-dose midazolam sedation: An option for patients undergoing serial hepatic venous pressure measurements

The hepatic venous pressure gradient (HVPG) is becoming increasingly used c linically It is useful in the differential diagnosis of portal hypertension and provides a prognostic index in cirrhotic patients. Performance of seri al measurements has been shown to be useful in guiding pharmacological ther apy of portal hypertension and variceal hemorrhage. The technique is safe t o perform; however, many patients are anxious and reluctant to undergo seri al measurements. The effects of sedatives on portal pressure measurements h ave not yet been defined. The objective of this study was to evaluate the e ffects of midazolam on the HVPG. Twenty patients with compensated cirrhosis were included in this prospective, double-blind study. The HVPG was determ ined by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP), Patients were randomized to receive either placebo, 0.02 mg/kg midazolam, or 0.03 mg/kg midazolam, administered intra venously over 3 minutes. Immediately after drug administration and every 3 minutes thereafter, for a total of 30 or 40 minutes, measurements were repe ated. Three hours later, patients were asked to state whether the sedative affected their state of comfort/relaxation. The effects of both doses of mi dazolam on HVPG did not differ significantly from those of placebo. Further more, neither dose of midazolam induced significant changes in HVPG as comp ared with baseline values. However, higher-dose midazolam (0.03 mg/kg) was associated with significant reductions in FHVP from baseline and a tendency for a reduction in WHVP. Both doses significantly increased patient comfor t and relaxation during the test. Midazolam, used at a dose of 0.02 mg/kg, is effective in increasing patient comfort and relaxation during hepatic ve nous pressure measurements, without significantly affecting pressures (HVPG , WHVP, or FHVP). It is therefore an acceptable option for patients undergo ing serial hepatic venous pressure measurements.