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Midazolam as an induction agent in mitral stenosis patients for closed mitral commissurotomy
G D Puri1, S Palvannan, P Chari
1Department of Anaesthesiology, Postgraduate Institute of Medical Education & Research, Chandigarh.
Abstract:
In 30 patients of rheumatic heart disease with mitral stenosis (MS) belonging to NYHA class II and III scheduled for closed mitral commissurotomy anaesthesia was induced with morphine 0.15 mg/kg followed by either thiopentone (group A, n = 15) or midazolam (group B, n = 15) titrated to produce sleep. Patients were intubated with pancuronium bromide in a dose of 0.12 mg/kg. Minimum mean arterial blood pressure following induction was significantly lower in thiopentone group (77 +/- 7 mm Hg) than midazolam group (85 +/- 6 mm Hg; P < 0.05). After intubation blood pressure was significantly higher in thiopentone group (99 +/- 8 mm Hg) than midazolam group patients (89 +/- 7 mm Hg). Heart rate was significantly higher in thiopentone treated patients both before and after endotracheal intubation. During surgery, three patients in group A had hypotensive episodes (mean arterial blood pressure 20% below basal at two successive readings 5 min apart) while one in group B had a hypotensive episode. Average duration of surgery was comparable between the two groups (102 +/- 15 and 95 +/- 18 min) and postoperatively there was no significant difference in sedation score and incidence of nausea and vomiting between the two groups.
Insights
Midazolam provided a more stable hemodynamic profile during anesthesia for mitral stenosis patients undergoing closed mitral commissurotomy compared to thiopentone. This suggests midazolam may be a safer anesthetic induction agent for this patient population.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Rheumatic heart disease with mitral stenosis (MS) often requires surgical intervention.
- Closed mitral commissurotomy is a procedure used to treat MS.
- Anesthetic management is critical for patients with MS due to potential hemodynamic instability.
Purpose of the Study:
- To compare the hemodynamic effects of midazolam versus thiopentone for anesthetic induction in patients with mitral stenosis undergoing closed mitral commissurotomy.
- To evaluate the safety and efficacy of these anesthetic agents in this specific patient group.
Main Methods:
- A randomized study of 30 patients with NYHA class II/III rheumatic heart disease and MS.
- Anesthesia induced with morphine followed by either thiopentone or midazolam.
- Patients intubated with pancuronium bromide.
- Hemodynamic parameters (mean arterial blood pressure, heart rate) monitored throughout.
Main Results:
- Thiopentone group showed significantly lower minimum mean arterial blood pressure post-induction (77 +/- 7 mmHg) compared to midazolam (85 +/- 6 mmHg).
- Heart rate was significantly higher in the thiopentone group both before and after intubation.
- Hypotensive episodes occurred in 3 patients in the thiopentone group versus 1 in the midazolam group.
Conclusions:
- Midazolam offers a more stable hemodynamic profile during anesthetic induction for closed mitral commissurotomy in MS patients compared to thiopentone.
- Midazolam may be a preferable anesthetic induction agent for patients with mitral stenosis undergoing this procedure.