Summary
Midazolam maleate is a new water soluble benzodiazepine used for induction of anaesthesia. Ten patients with symptomatic ischaemic heart disease were premedicated intramuscularly with morphine 0.l mg · kg-1 and scopolamine 6–8 µg · kg-1, 60–90 minutes before induction. The heart rate, systolic/diastolic blood pressure, mean systolic blood pressure, mean pulmonary artery blood pressure, pulmonary artery occluded pressure, mean right atrial pressure, cardiac output (duplicate thermodilution) and arterial blood gas tensions were measured at four time periods: (1) after instrumentation while breathing room air, (2) after transfer to the operating room while breathing 100 percent oxygen by mask, (3) one to two minutes after intravenous midazolam maleate 0.2 mg · kg-1 and (4) four to five minutes after midazolam maleate. The cardiac index, stroke index, heart ratesystolic blood pressure product, systemic vascular resistance index, pulmonary vascular resistance index, left ventricular stroke work index and right ventricular stroke work index were calculated for each of the study time-periods from the measured parameters.
Midazolam maleate anaesthetized all patients and times for induction ranged from 30 to 90 seconds (mean 44). Apnoea occurred in 75 per cent of patients and ventilation was assisted in those instances. The\(Pa_{o_2 } \) was unchanged by midazolam maleate, but the\(Pa_{co_2 } \) rose significantly (p < 0.02) from 5.32 ± 0.19 to 5.85 ± 0.17kPa(40 ± 1.4 to 44 ± 1.3 mm Hg) (1–2 min) and 6.1 ± 0.17 kPa (46 ± 1.3 mm Hg) (4–5 minutes after midazolam maleate).
Haemodynamic effects of midazolam maleate were minor and in most cases less than those associated with transfer of the patients to the operating room when the systemic systolic/diastolic blood pressure, mean systemic blood pressure, mean right atrial pressure, pulmonary artery occluded pressure and systemic vascular resistance index alt significantly increased (p < 0.01). Midazolam maleate significantly reduced systemic systolic/diastolic pressure, mean systemic blood pressure, stroke volume, left and right ventricular stroke work index and systemic vascular resistance index toward the original resting control.
The heart rate rose from 55 ± 6.6 to 66 ± 5.3 beats per minute (p < 0.01) one to two minutes after midazolam maleate, and the mean right atrial pressure, mean pulmonary artery pressure, pulmonary artery occluded pressure, cardiac index, stroke index, pulmonary vascular resistance index and heart rate-systolic blood pressure product remained unchanged. There were no further significant changes four to five minutes after midazolam maleate, except in systemic systolic/diastolic pressure which continued to decline to the level of the resting control (125/61).
It is concluded that the rapid action of midazolam maleate and its modest effects on haemodynamic parameters, make it a safe and efficacious induction agent in patients with ischaemic heart disease.
Résumé
Le maléate de midazolam est une nouvelle benzodiazépine soluble dans ľeau utilisée comme agent ďinduction en anesthésie. Notre étude a porté sur dix patients présentant une pathologie coronarienne symptomatique et soumis à une chirurgie de revascularisation. Une injection de morphine (à la dose de 0.1 mg · kg-1) et de scopolamine (6 à 8 µg · kg-1) a été administrée en prémédication 60 à 90 minutes avant ľinduction. La fréquence cardiaque. les pressions systémiques systolique, diastolique et moyenne, la pression pulmonaire moyenne et la pression capillaire bloquée. la pression auriculaire droite moyenne, le débit cardiaque par thermodilution ainsi que les gaz artériels ont été mesurés et enregistrés à quatre moments: (1) Après ľinstallation des canules dans la chambre de pié-induction alors que le malade respirait ľair de la pièce. (2) Après le transfert du patient en suite ďopération et sous ventilation spontanée à 100 pour cent ďoxygène. (3) Une à deux minutes après ľinjection de maléate de midazolam à la dose de 0.2 mg · kg-1. (4) Quatre à cinq minutes après cette même injection. Ľindex cardiaque, ľindex ďéjection, le produit fréquence cardiaque-pression systolique, les index de résistance vasculaire systémique et pulmonaire, les index de travail ďéjection ventriculaire gauche et droit ont également été calculés aux mêmes temps.
Le midazolam a produit ľhypnose chez tous les patients entre 30 et 90 secondes (moyenne de 44 secondes).
Une apnée de 15 à 60 secondes a été observée dans 75 pour cent des cas alors que la ventilation a été assistée.
La\(Pa_{o_2 } \) est demeurée inchangée après ľinjection alors que la\(Pa_{co_2 } \) s’est élevée de façon significative (p < 0.02) passant de 5.32 ± 0.19 à 5.85 ± 0.17 kPa (46 ± 1.3 mm Hg) quatre à cinq minutes après le midazolam.
Les effets hémodynamiques observés ont été mineurs et moins importants dans la plupart des cas que ceux associes au transfert des patients en salle ďopération alors que les pressions artérielles systolique, diastolique et moyenne, que la pression capillaire bloquée et que ľindex de résistance vasculaire systémique se sont tous élevés de façon significative (p < 0.01). Le midazolam a diminué significativement les pressions artérielles systémiques (systolique, diastolique et moyenne), le volume ďéjection, les index de travail ventriculaire gauche et droit ainsi que ľindex de résistance vasculaire périphérique, tout cela vers des valeurs voisines des valeurs-contrôles.
La fréquence cardiaque s’est élevée de 55 ± 6.6 à 66 ± 5.3 par minute, une à deux minutes après ľinjection de la benzodiazépine alors que les pressions artérielles moyennes systémiques et pulmonaires, les pressions pulmonaires bloquées, les index cardiaques, ľindex ďéjection et celui de la résistance vasculaire pulmonaire ainsi que le produit pression-frequence demeuraient inchangés. Ľon n’a pas observé ďautres modifications significatives quatre ou cinq minutes après ľinjection si ce n’est le maintien du déclin des pressions systémiques systoliques et diastoliques vers les niveaux-contrôles (125/61).
Nous concluons que la rapidité ďaction du maléate de midazolam et ses effets hémodynamiques légers en font un agent ďinduction sûr et efficace chez les coronariens.
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Reves, J.G., Samuelson, P.N. & Lewis, S. Midazolam maleate induction in patients with ischaemic heart disease: Haemodynamic observations. Canad.Anaes.Soc.J. 26, 402–409 (1979). https://doi.org/10.1007/BF03006455
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DOI: https://doi.org/10.1007/BF03006455