Comparison of Effectiveness and Side Effects of Diazepam versus Midazolam Administration for Conscious Sedation in Patients Who Underwent Cataract Surgery
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Abstract
Background: The purpose of this study was to compare the effectiveness and side effects of diazepam and midazolam administration for conscious sedation in subjects who undergoing cataract surgery.
Methods: A total of 79 patients undergoing cataract surgery under topical anesthesia with conscious sedation were prospectively reviewed. Our subjects were randomly divided to two groups. The first group comprised of 38 cases receiving 0.05 mg/kg diazepam slow intravenously (diazepam group) and the second group comprised of 41 cases receiving 0.01 mg/kg midazolam intravenously (midazolam group). Intraoperative variables such as systolic and diastolic arterial pressure, heart rate, respiratory rate and blood oxygen saturation were recorded immediately before sedation, 5, 10 and 15 minutes after diazepam or midazolam administration. All patients were contacted 24 hours after the operation for any early postoperative complications.
Results: The variability of systolic and diastolic blood pressure at 5, 10 and 15 minutes after sedation were statistically significantly higher in midazolam group compared to diazepam group. Six patients developed episodes of apnea during operation, two patients in diazepam and four patients in midazolam group. The surgeons’ satisfaction was more in diazepam group but not statistically significant. Need for additional dose of benzodiazepine was more in the midazolam group. Drowsiness and functional impairment during 24 hours after surgery were not significantly different between the two groups.
Conclusion: Diazepam produces better perioperative hemodynamic profile, level of sedation and surgeon’s satisfaction and less occurrence of apnea compared to midazolam group in patients who underwent cataract surgery.
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2. Sajedi P, Nejad MS, Montazeri K, Baloochestani E. Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anesthesia. Int J Prev Med. 2013; 4(11):1258-65.
3. Sharwood PL, Thomas D, Roberts TV. Adverse medical events associated with cataract surgery performed under topical anaesthesia. Clin Exp Ophthalmol. 2008; 36(9):842-6.
4. Sabanayagam C, Wang JJ, Mitchell P, Tan AG, Tai ES, Aung T, Saw SM, Wong TY. Metabolic syndrome components and age-related cataract: the Singapore Malay eye study. Invest Ophthalmol Vis Sci. 2011; 52(5):2397-404.
5. Fabian LW, Krechel SW. Aging and intravenous anesthetics. In: Anesthesia and the Geriatric Patient. Krechel SW (Ed.). Orlando Grune & Stratton, 1984:115-26.
6. Reves JG, Fragen R J, Vinik R, Greenblatt DJ. Midazolam: pharmacology and uses. Anesthesiology 1985; 62: 310-24.
7. U.S. is asked to sharply limit use of sedative. The New York Times, February 14, 1988, section I, p. 37.
8. Gross JB, Blouin RT, Zandsberg S, Conard PF, Häussler J. Effect of flumazenil on ventilatory drive during sedation with midazolam and alfentanil. Anesthesiology. 1996; 85(4):713-20.
9. Zakko SF, Seifert HA, Gross JB. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study. Gastrointest Endosc. 1999; 49(6):684-9.
10. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990; 10(4):244-51.
11. Pham DT, Castello R. [Topical anaesthesia in cataract surgery]. Klin Monbl Augenheilkd. 2010; 227(8):605-10.
12. Ho AL, Zakrzewski PA, Braga-Mele R. The effect of combined topical-intracameral anaesthesia on neuroleptic requirements during cataract surgery. Can J Ophthalmol. 2010; 45(1):52-7.
13. Altamura AC, Moliterno D, Paletta S, Maffini M, Mauri MC, Bareggi S. Understanding the pharmacokinetics of anxiolytic drugs. Expert Opin Drug Metab Toxicol. 2013; 9(4):423-40.
14. Lewis BS, Shlien RD, Wayne JD, Knight RJ, Aldoroty RA. Diazepam versus midazolam (versed) in outpatient colonoscopy: a double-blind randomized study. Gastrointest Endosc. 1989; 35(1):33-6.
15. Whitwam JG, Al-Khudhairi D, McCloy RF. Comparison of midazolam and diazepam in doses of comparable potency during gastroscopy. Br J Anaesth. 1983; 55(8):773-7.
16. Cole SG, Brozinsky S, Isenberg JI. Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of preendoscopic sedatives. Gastrointest Endosc. 1983; 29(3):219-22.
17. Magni VC, Frost RA, Leung JW, Cotton PB. A randomized comparison of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. Br J Anaesth. 1983; 55(11):1095-101.
18. Chung F, Cheng DC, Seyone C, Dyck BJ. A randomized comparison of midazolam and diazepam injectable emulsion in cataract surgery. Can J Anaesth. 1990; 37(5):528-33.
19. Greenblatt DJ, Abernethy DR, Locniskar A, Harmatz JS, Limjuco RA, Shader RI. Effect of age, gender, and obesity on midazolam kinetics. Anesthesiology. 1984; 61(1):27-35.
20. Macken E, Gevers AM, Hendrickx A, Rutgeerts P. Midazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil. Gastrointest Endosc. 1998; 47(1):57-61.
21. Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg. 1989; 68(3):368-76.
22. Buhrer M, Maitre PO, Crevoisier C, Hung O, Stanski DR. Comparative pharmacodynamics of midazolam and diazepam. Anesthesiology. 1988; 69: A642.
23. Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980; 53(6):494-7.
24. Bell GD, Morden A, Coady T, Lee J, Logan RF. A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation. Br J Clin Pharmacol. 1988; 26(5):595-600.
25. Eriksson I, Berggren L. Effects of repeated doses of benzodiazepines on arterial blood gases and transcutaneous PO2. Acta Anaesthesiol Scand. 1987; 31(5):357-61.
26. Power SJ, Morgan M, Chakrabarti MK. Carbon dioxide response curve following midazolam and diazepam. Br J Anaesth. 1983; 55: 837-41.
27. Gross JB, Bailey, PL, Caplan RA, Connis RT, Cote´ CJ, Davis FG, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists: a report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 1996; 84:459-71.
28. Gross JB, Long WB. Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine. Gastrointest Endosc. 1990; 36(1):26-9.
29. Sanatkar M, Sadeghi M, Esmaeili N, Sadrossadat H, Shoroughi M, Ghazizadeh S, Khoshraftar E, Pour Anvari H, Alipour N. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction. Acta Med Iran. 2013; 51(7):438-43.
30. Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran. 2015; 53(3):158-61.
31. Moezi L, Shafaroodi H, Sarkar S, Emami-Razavi SH, Sanatkar M, Mirazi N, Dehpour AR. Involvement of nitrergic and opioidergic systems in the hypothermia induced by cholestasis in rats. Pathophysiology. 2006; 13(4):227-32.
32. Bakhshaei MH1, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran. 2010; 48(6):380-4.
33. Sebghatollahi V, Tabesh E, Gholamrezaei A, Zandi AR, Minakari M, Shavakhi A. Premedication with benzodiazepines for upper gastrointestinal endoscopy: Comparison between oral midazolam and sublingual alprazolam. J Res Med Sci. 2017; 22:133. 28.
34. Jeon S, Lee HJ, Do W, Kim HK, Kwon JY, Hwang BY, et al. Randomized controlled trial assessing the effectiveness of midazolam premedication as an anxiolytic, analgesic, sedative, and hemodynamic stabilizer. Medicine (Baltimore). 2018; 97(35):e12187.
35. Teixeira AL, Ramos PS, Samora M, Sabino-Carvalho JL, Ricardo DR, Colombari E, et al. GABAergic contribution to the muscle mechanoreflex-mediated heart rate responses at the onset of exercise in humans. Am J Physiol Heart Circ Physiol. 2018; 314(4):H716-H723. 27.
2. Sajedi P, Nejad MS, Montazeri K, Baloochestani E. Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anesthesia. Int J Prev Med. 2013; 4(11):1258-65.
3. Sharwood PL, Thomas D, Roberts TV. Adverse medical events associated with cataract surgery performed under topical anaesthesia. Clin Exp Ophthalmol. 2008; 36(9):842-6.
4. Sabanayagam C, Wang JJ, Mitchell P, Tan AG, Tai ES, Aung T, Saw SM, Wong TY. Metabolic syndrome components and age-related cataract: the Singapore Malay eye study. Invest Ophthalmol Vis Sci. 2011; 52(5):2397-404.
5. Fabian LW, Krechel SW. Aging and intravenous anesthetics. In: Anesthesia and the Geriatric Patient. Krechel SW (Ed.). Orlando Grune & Stratton, 1984:115-26.
6. Reves JG, Fragen R J, Vinik R, Greenblatt DJ. Midazolam: pharmacology and uses. Anesthesiology 1985; 62: 310-24.
7. U.S. is asked to sharply limit use of sedative. The New York Times, February 14, 1988, section I, p. 37.
8. Gross JB, Blouin RT, Zandsberg S, Conard PF, Häussler J. Effect of flumazenil on ventilatory drive during sedation with midazolam and alfentanil. Anesthesiology. 1996; 85(4):713-20.
9. Zakko SF, Seifert HA, Gross JB. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study. Gastrointest Endosc. 1999; 49(6):684-9.
10. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990; 10(4):244-51.
11. Pham DT, Castello R. [Topical anaesthesia in cataract surgery]. Klin Monbl Augenheilkd. 2010; 227(8):605-10.
12. Ho AL, Zakrzewski PA, Braga-Mele R. The effect of combined topical-intracameral anaesthesia on neuroleptic requirements during cataract surgery. Can J Ophthalmol. 2010; 45(1):52-7.
13. Altamura AC, Moliterno D, Paletta S, Maffini M, Mauri MC, Bareggi S. Understanding the pharmacokinetics of anxiolytic drugs. Expert Opin Drug Metab Toxicol. 2013; 9(4):423-40.
14. Lewis BS, Shlien RD, Wayne JD, Knight RJ, Aldoroty RA. Diazepam versus midazolam (versed) in outpatient colonoscopy: a double-blind randomized study. Gastrointest Endosc. 1989; 35(1):33-6.
15. Whitwam JG, Al-Khudhairi D, McCloy RF. Comparison of midazolam and diazepam in doses of comparable potency during gastroscopy. Br J Anaesth. 1983; 55(8):773-7.
16. Cole SG, Brozinsky S, Isenberg JI. Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of preendoscopic sedatives. Gastrointest Endosc. 1983; 29(3):219-22.
17. Magni VC, Frost RA, Leung JW, Cotton PB. A randomized comparison of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. Br J Anaesth. 1983; 55(11):1095-101.
18. Chung F, Cheng DC, Seyone C, Dyck BJ. A randomized comparison of midazolam and diazepam injectable emulsion in cataract surgery. Can J Anaesth. 1990; 37(5):528-33.
19. Greenblatt DJ, Abernethy DR, Locniskar A, Harmatz JS, Limjuco RA, Shader RI. Effect of age, gender, and obesity on midazolam kinetics. Anesthesiology. 1984; 61(1):27-35.
20. Macken E, Gevers AM, Hendrickx A, Rutgeerts P. Midazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil. Gastrointest Endosc. 1998; 47(1):57-61.
21. Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg. 1989; 68(3):368-76.
22. Buhrer M, Maitre PO, Crevoisier C, Hung O, Stanski DR. Comparative pharmacodynamics of midazolam and diazepam. Anesthesiology. 1988; 69: A642.
23. Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980; 53(6):494-7.
24. Bell GD, Morden A, Coady T, Lee J, Logan RF. A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation. Br J Clin Pharmacol. 1988; 26(5):595-600.
25. Eriksson I, Berggren L. Effects of repeated doses of benzodiazepines on arterial blood gases and transcutaneous PO2. Acta Anaesthesiol Scand. 1987; 31(5):357-61.
26. Power SJ, Morgan M, Chakrabarti MK. Carbon dioxide response curve following midazolam and diazepam. Br J Anaesth. 1983; 55: 837-41.
27. Gross JB, Bailey, PL, Caplan RA, Connis RT, Cote´ CJ, Davis FG, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists: a report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 1996; 84:459-71.
28. Gross JB, Long WB. Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine. Gastrointest Endosc. 1990; 36(1):26-9.
29. Sanatkar M, Sadeghi M, Esmaeili N, Sadrossadat H, Shoroughi M, Ghazizadeh S, Khoshraftar E, Pour Anvari H, Alipour N. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction. Acta Med Iran. 2013; 51(7):438-43.
30. Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran. 2015; 53(3):158-61.
31. Moezi L, Shafaroodi H, Sarkar S, Emami-Razavi SH, Sanatkar M, Mirazi N, Dehpour AR. Involvement of nitrergic and opioidergic systems in the hypothermia induced by cholestasis in rats. Pathophysiology. 2006; 13(4):227-32.
32. Bakhshaei MH1, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran. 2010; 48(6):380-4.
33. Sebghatollahi V, Tabesh E, Gholamrezaei A, Zandi AR, Minakari M, Shavakhi A. Premedication with benzodiazepines for upper gastrointestinal endoscopy: Comparison between oral midazolam and sublingual alprazolam. J Res Med Sci. 2017; 22:133. 28.
34. Jeon S, Lee HJ, Do W, Kim HK, Kwon JY, Hwang BY, et al. Randomized controlled trial assessing the effectiveness of midazolam premedication as an anxiolytic, analgesic, sedative, and hemodynamic stabilizer. Medicine (Baltimore). 2018; 97(35):e12187.
35. Teixeira AL, Ramos PS, Samora M, Sabino-Carvalho JL, Ricardo DR, Colombari E, et al. GABAergic contribution to the muscle mechanoreflex-mediated heart rate responses at the onset of exercise in humans. Am J Physiol Heart Circ Physiol. 2018; 314(4):H716-H723. 27.
| Files | ||
| Issue | Vol 5 No 3 (2019): Summer |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v5i3.1204 | |
| Keywords | ||
| Diazepam Midazolam Cataract surgery Conscious sedation Topical anesthesia | ||
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How to Cite
1.
Sanatkar M, Shorooghi M, Sanie MS. Comparison of Effectiveness and Side Effects of Diazepam versus Midazolam Administration for Conscious Sedation in Patients Who Underwent Cataract Surgery. Arch Anesth & Crit Care. 2019;5(3):81-85.
