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[Premedication in ENT operations under local anesthesia].

J C van Drie, S van der Baan, J J Nauta

    Nederlands Tijdschrift Voor Geneeskunde
    |October 7, 1989
    PubMed
    Summary
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    Oral midazolam (MDZ) at 25 mg is a satisfactory premedication for ear surgery, offering better sedation and less pain than older drug combinations. This short-acting option is useful for day-care surgery.

    Area of Science:

    • Anesthesiology
    • Pharmacology

    Background:

    • Premedication is crucial for managing patient anxiety and comfort during surgical procedures.
    • Traditional premedication regimens can be complex and may have drawbacks.

    Purpose of the Study:

    • To compare oral midazolam with a combination of pentobarbital, promethazine, opial, and scopolamine for ear surgery.
    • To determine the optimal oral midazolam dosage for pre-operative sedation.
    • To evaluate the efficacy of additional morphine for pain management during local anesthesia administration.

    Main Methods:

    • Three double-blind clinical trials were conducted.
    • Study 1: Midazolam 15 mg vs. combination regimen.
    • Study 2: Midazolam 15 mg, 20 mg, and 25 mg.
    • Study 3: Midazolam 25 mg with or without intramuscular morphine.

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    Main Results:

    • The pentobarbital combination provided better sedation and pain relief than initial midazolam dose.
    • Higher midazolam doses (20-25 mg) showed satisfactory results.
    • 25 mg oral midazolam was effective and less troublesome than the combination regimen.
    • Pain during local anesthesia occurred in 16% of patients, unaffected by added morphine.

    Conclusions:

    • 25 mg oral midazolam, administered 45 minutes pre-operatively, is a suitable premedication for ear surgery.
    • Midazolam offers a less troublesome and effective alternative to older drug combinations.
    • This short-acting premedication is beneficial for day-care surgery settings.