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Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization
William Black1, Raj Baljepally1, Laylan Shali1
1University of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USA.
Journal of Interventional Cardiology
|August 18, 2021
Summary
Midazolam monotherapy provides comparable pain relief to midazolam plus fentanyl for cardiac catheterization. This study suggests avoiding fentanyl for procedural sedation due to its risks and costs.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Procedural sedation is crucial for patient comfort during cardiac catheterization.
- The combination of midazolam and fentanyl is standard, but its superiority over midazolam monotherapy lacks comparative study.
Purpose of the Study:
- To compare pain perception in patients undergoing cardiac catheterization sedated with midazolam monotherapy versus midazolam plus fentanyl.
Main Methods:
- 129 patients were randomized to midazolam monotherapy or midazolam plus fentanyl.
- Pain was assessed using a questionnaire and a 10-point Likert scale post-procedure.
Main Results:
- 73% of patients reported no pain.
- Midazolam monotherapy and combination therapy resulted in similar average pain scores (1.1 vs. 1.1, p=0.95).
Conclusions:
- Midazolam monotherapy is as effective as midazolam plus fentanyl for pain management during cardiac catheterization.
- Cardiologists should reconsider fentanyl use due to risks, costs, and addiction potential, favoring single-agent sedation.
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