Audit on preoperative midazolam and level of sedation

We wished to observe by carrying out a prospective clinical audit, the level of sedation and time interval of all adult elective surgery patients. We enrolled adult ASA I-III patients who came for elective surgery to the Aga Khan University Hospital preoperative surgery suite for 3 months. Hundred patients were enrolled. The majority of patients got 7.5 mg of PO Midazolam. Our median Ramsay sedation score was 2 and the Median drug to door time was 52.35 minutes. 11 patients were reportedly 'drowsy' in the recovery room one hour after surgery was completed. These were mostly the same patients who had a higher (Ramsay V) sedation score in the preoperative period (p = 0.36). There was no significant difference in the 2 midazolam dosages and the Ramsay sedation score (p = 0.12). We concluded that our sedation score is too low and our median time interval is too long making most patients coming for surgery under sedated. We recommend calling the patients in the OR suite one hour prior and the dosage being prescribed by the primary anaesthetist in order to keep this standardized.