MIDAZOLAM AS AN INDUCTION AGENT IN MITRAL-STENOSIS PATIENTS FOR CLOSED MITRAL COMMISSUROTOMY

In 30 patients of rheumatic heart disease with mitral stenosis (MS) be longing to NYHA class II and III scheduled for closed mitral commissur otomy anaesthesia was induced with morphine 0.15 mg/kg followed by eit her thiopentone (group A, n = 15) or midazolam (group B, n = 15) titra ted to produce sleep. Patients were intubated with pancuronium bromide in a dose of 0.12 mg/kg. Minimum mean arterial blood pressure followi ng induction was significantly lower in thiopentone group (77 +/- 7 mm Hg) than midazolam group (85 +/- 6 mm Hg; P<0.05). After intubation b lood pressure was significantly higher in thiopentone group (99 +/- 8 mm Hg) than midazolam group patients (89 +/- 7 mm Hg). Heart rate was significantly higher in thiopentone treated patients both before and a fter endotracheal intubation. During surgery, three patients in group A had hypotensive episodes (mean arterial blood pressure 20% below bas al at two successive readings 5 min apart) while one in group B had a hypotensive episode. Average duration of surgery was comparable betwee n the two groups (102 +/- 15 and 95 +/- 18 min) and postoperatively th ere was no significant difference in sedation score and incidence of n ausea and vomiting between the two groups.