[Midazolam (Dormicum) as oral premedication for local anesthesia]

Good physician-patient rapport and an anxiolytic, sedative, and amnesic premedication are necessary for comfortable, stress-free surgery under local anesthesia. Sufficient experience exists with the intramuscular and intravenous administration of the new benzodiazepine midazolam (Dormicum), while knowledge relating to its oral administration is still scant. Therefore, in a randomized double-blind study midazolam was investigated for oral premedication prior to local anesthesia: two dosages of midazolam were studied and compared with diazepam and placebo. One hour prior to ophthalmic surgery under local anesthesia, four randomized groups of 30 patients each, received a tablet of 7.5 or 15 mg midazolam, 10 mg diazepam, or a placebo. Following this medication, the anxiolytic, sedative, amnesic, and side-effects were determined at defined points of time during the day of surgery and the 1st postoperative day. Anxiolysis was determined using the "state-trait anxiety inventory (STAI)" of Spielberger et al.; sedation was assessed according to Pandit et al.; amnesia was determined by recall of picture cards which had been presented to the patients 50 min after premedication; and patients were asked about 13 side-effects typical of benzodiazepines in a standardized way. Anxiety increased little following the placebo; it decreased significantly following 10 mg diazepam and more markedly following 7.5 and 15 mg midazolam. Sedation increased little following the placebo; it increased more and similarly 50 min after the benzodiazepines; after 90 min the sedative effect was most marked for 15 mg midazolam. However, sedation was of shorter duration after midazolam than after diazepam.(ABSTRACT TRUNCATED AT 250 WORDS)