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Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.

Publication ,  Journal Article
Newman, M; Reves, JG
Published in: J Cardiothorac Vasc Anesth
October 1993

Having examined the options for adjuvant drug use during cardiac anesthesia, it becomes increasingly apparent that midazolam is "the drug" of choice and that supplementation with an opioid is an ideal adjuvant. In the hands of experienced cardiac anesthesiologists, the majority of the drugs discussed could provide adequate anesthesia with outcomes that would be difficult to distinguish, with the exception of awakening and time to extubation. Regardless of the inability to differentiate overall outcome, when comparing ease of providing complete "balanced" anesthesia, minimal cost increase, ease of use, hemodynamic stability, reliability of amnesia and ability to decrease narcotic requirement and allow early extubation, midazolam is a clear winner. Given as a continuous infusion or a bolus, potent opioids such as alfentanil, fentanyl or sufentanil enhance the amnestic and hypnotic effect of midazolam, decreasing the required dose. In addition, the combination of midazolam and narcotics decreases the catecholamine response that either one alone would produce. This removes the necessity of marked narcotic overdose required when narcotics alone are used. The result of this anesthetic combination is a technique that can be used in the majority of cardiac patients regardless of their ventricular performance, allowing options for earlier awakening, earlier extubation and decreased ICU stay. The goal of complete "balanced" anesthesia is best achieved with continuous infusions of midazolam and opioids. Accepting recall of intraoperative events as a necessary evil is unacceptable in the stable cardiac surgery patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

ISSN

1053-0770

Publication Date

October 1993

Volume

7

Issue

5

Start / End Page

615 / 619

Location

United States

Related Subject Headings

  • Narcotics
  • Midazolam
  • Humans
  • Hemodynamics
  • Fentanyl
  • Anesthesiology
  • Anesthesia, Intravenous
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Newman, M., & Reves, J. G. (1993). Pro: midazolam is the sedative of choice to supplement narcotic anesthesia. J Cardiothorac Vasc Anesth, 7(5), 615–619. https://doi.org/10.1016/1053-0770(93)90325-f
Newman, M., and J. G. Reves. “Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.J Cardiothorac Vasc Anesth 7, no. 5 (October 1993): 615–19. https://doi.org/10.1016/1053-0770(93)90325-f.
Newman M, Reves JG. Pro: midazolam is the sedative of choice to supplement narcotic anesthesia. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):615–9.
Newman, M., and J. G. Reves. “Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.J Cardiothorac Vasc Anesth, vol. 7, no. 5, Oct. 1993, pp. 615–19. Pubmed, doi:10.1016/1053-0770(93)90325-f.
Newman M, Reves JG. Pro: midazolam is the sedative of choice to supplement narcotic anesthesia. J Cardiothorac Vasc Anesth. 1993 Oct;7(5):615–619.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

ISSN

1053-0770

Publication Date

October 1993

Volume

7

Issue

5

Start / End Page

615 / 619

Location

United States

Related Subject Headings

  • Narcotics
  • Midazolam
  • Humans
  • Hemodynamics
  • Fentanyl
  • Anesthesiology
  • Anesthesia, Intravenous
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology