[Role of benzodiazepines in neuroanesthesia]

For the induction of anesthesia in neurosurgical patients, the choice between thiopental and midazolam cannot be done on the basis of their respective cardiovascular, respiratory or cerebral effects, since they are similar. Among the advantages of midazolam are the absence of histamine release and excitatory effects. On the contrary the onset and the duration of action as well as the intensity of sedation are less predictable with midazolam when compared to thiopental. Therefore thiopental remains the first drug of choice in this clinical setting. For preoperative sedation in neurosurgical patients, the use of benzodiazepines should be limited, since they can induce respiratory depression mainly in patients with cranial trauma or with chronic obstructive pulmonary disease. The preoperative administration of a benzodiazepine in neurosurgical patients who are under chronic treatment should be decided individually, according to the level of the conscience of the patient and on the half life of the drug.