Effects of midazolam (a benzodiazepine) on cerebral perfusion and oxygenation in dogs

Midazolam is a water-soluble benzodiazepine used for anesthetic induction. Its effects on the cerebral circulation are still controversial. We evaluated the effects of midazolam on the cerebral blood flow (CBF), cerebral vascular resistance (CVR), and cerebral oxygen consumption (CMRO2) in dogs (n = 6) using the cerebral venous outflow method. CVR was calculated as the quotient of mean arterial pressure (MAP) and CBF, CMRO2 was obtained from the measurements of CBF and arterio-venous O2 difference (A-V dO2). Midazolam was administered in sequential i.v. doses of 0.5, 1.0, and 2.0 mg/kg by bolus injection with an interval of 20 min. This agent significantly reduced the MAP, CBF and CMRO2, but did not affect the CVR. The maximal decreases in MAP, CBF, and CMRO2 from the control levels averaged 14.8%, 12.2%, and 9.3%, respectively, by 0.5 mg/kg; 18.9% 18.6% and 12.1% by 1.0 mg/kg; and 23.6%, 18.7% and 16.1% by 2.0 mg/kg. Although the increments in doses further depressed that MAP, CBF and CMRO2, the dose-dependent effects were slight. Only the values of reduction in CMRO2 were significantly different between the doses of 0.5 and 2.0 mg/kg. Therefore, a dose of 0.5 mg/kg produced nearly the maximal effects. The results indicate that midazolam causes a mild reduction (10-25%) in arterial pressure, brain perfusion and cerebral oxygenation. Cerebral vascular resistance is not significantly changed.