Midazolam comparative studies

Mahajan R, Batra YK, Grover VK, Kajal J. A comparative study of caudal bupivacaine and midazolam-bupivacaine mixture for post-operative analgesia in children undergoing genitourinary surgery. Int J Clin Pharmacol Ther 2001 39(3) 116-20. 

Observational studies Several studies have reported better recovery with a combination of remifentanil + midazolam compared with combinations of fentanyl +midazolam and... 

Midazolam, Triazolam, and Flurazepam The feasibility of intranasal administration of midazolam, flurazepam, and triazolam has been studied and compared with oral absorption in dogs. There was a 3.4-fold increase in the Cmax after nasal administration, from 5.5-8.7ng/mL to 17.4-30.0 ng/mL. The mean tm showed comparable values for both routes. The Tnmx obtained after nasal administration of midazolam was found to be 15 min, as compared with the 15-45 min observed for oral dosing, while the Cmax after nasal administration was 6.5-20.3 ng/mL, as compared with 3.0-8.6ng/mL observed for the oral route. Like midazolam and triazolam, flurazepam also showed a shorter half-life, 15 min, as compared with 15 15 min with oral administration. The Cmax for oral administration was 0.14-0.59 ng/mL after nasal administration it was in the range of 2.6-11.1 ng/mL, a 16.4-fold increase. Since the gastrointestinal tract at bedtime is likely to be in the fed state, causing a twofold decrease in the absorption of midazolam and triazolam, the nasal route may be a better option for the treatment of amnesia, since these drugs cross the nasal mucosa effectively without the use of an absorption enhancer, as shown in these studies [108],... 

Intranasal midazolam 0.2 mg/kg and intravenous diazepam 0.3 mg/kg have been compared in a prospective randomized study in 47 children (aged 6 months to 5 years) with prolonged (over 10 minutes) febrile seizures (55). Intranasal midazolam controlled seizures significantly earlier than intravenous diazepam. None of the children... 

In 113 patients undergoing general anesthesia, intravenous midazolam 15 mg slowed recovery of the twitch height after vecuronium and atracurium compared with diazepam. The recovery index was not altered (162). However, in another study in 20 patients, midazolam 0.3 mg/kg did not affect the duration of blockade, recovery time, intensity of fasciculations, or adequacy of relaxation for tracheal intubation produced by suxamethonium 1 mg/kg, nor the duration of blockade and adequacy of relaxation for tracheal intubation produced by pancuronium 0.025 mg/kg in incremental doses until 99% depression of muscle-twitch tension was obtained (161). Furthermore, in 60 patients undergoing maintenance anesthesia randomly assigned to one of six regimens (etomidate, fentanyl, midazolam, propofol, thiopental plus nitrous oxide, or isoflurane plus nitrous oxide), midazolam did not alter rocuronium dosage requirements (165). 

Recovery after propofol or midazolam has been compared in two studies (36,37). Memory was significantly impaired by midazolam, an effect that was reminiscent of the problems experienced with short-acting oral benzodiazepine hypnotics, such as triazolam. 

Forty anxious day-case patients undergoing extraction of third molar teeth under local anesthesia with sedation, were studied in a randomized, double-blind, controlled trial (38). A target-controlled infusion of propofol was compared with patient-controlled propofol for sedation, combined with a small dose of intravenous midazolam (0.03 mg/kg) to improve amnesia. Five patients became over-sedated in the target-controlled group compared with none in the patient-controlled group. 

The effects of intramuscular premedication with either clonidine 2 micrograms/kg or midazolam 70 micrograms/ kg on perioperative responses to ketamine anesthesia have been assessed in a placebo-controlled study in 30 patients (14). Clonidine significantly reduced intraoperative oxygen consumption, mean arterial pressure, and heart rate compared with midazolam and placebo. Thus, clonidine was as effective as midazolam, the standard drug used for this purpose, in reducing the undesirable sympathetic stimulation of ketamine. 

Midazolam (7.5 mg), flunitrazepam (Img), and placebo were compared in a double-blind crossover trial to study the effects of drugs on sleep, nighttime respiration, and body movements in five elderly insomniac patients. No signs of increased respiratory resistance was seen with either of the drugs or placebo. There were no differences in the quality and quantity of sleep induced by either drug. Only the sleep onset latency was shorter with flunitraz-epam compared with midazolam and placebo (80). 

Chamberlain IM, Altieri MA, Futterman C et al. (1997). A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care, 13, 92-94. 

It is very difficult to assess and compare the results of the very many studies of this interaction because of the differences between the tests, their duration, the dosages of the benzodiazepines and alcohol, whether given chronically or acutely, and a number of other variables. However, the overall picture seems to be that benzodiazepines and related drugs including diazepam, " alprazolam,bromazepam, brotizolam, chlo-rdiazepoxide, " clobazam, dipotassium clorazepate, flunitrazepam, flurazepam, loprazolam, " lorazepam, lormetazepam, medazepam, midazolam, nitrazepam, " " oxazepam, temazepam, " triazolam, and zopiclone enhance the effects of alcohol i.e. cause increased drowsiness, impaired performance and driving skills. 

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