Effects of midazolam and diazepam as premedication on heart rate variability in surgical patients

We have examined the effects of midazolam 0.06 mg kg-1 i.m. and diazepam 0.2 mg kg-1 orally as premedication on the spectral components of heart rate (HR) variability in 24 elderly patients aged 65-87 yr and 24 young patients aged 18-35 yr undergoing elective surgery. The low-frequency/high-frequency (LF/HF) ratio of HR variability increased after arrival in the operating room in elderly patients who received no premedication, but not in young patients. In elderly patients who received midazolam or diazepam, the LF/HF ratio did not increase. However, diazepam increased the low-frequency component and the total power of HR variability in both young and elderly patients. We conclude that cardiac sympathetic nerve activity increased after arrival in the operating room in the elderly, that midazolam or diazepam reduced this increase and that diazepam caused an increase in the total power of HR variability that has not been observed for other agents.