Midazolam as Intravenous Sedative f...

Midazolam as Intravenous Sedative for Electrocardioversion

Electrical cardioversion is commonly occupyed for the management of supraventricular tachyarrhythmias as well as ventricular tachycardia. Diazepam has been favorably used for conscious sedation to facilitate cardioversion. [1-3] Midazolam is another benzodiazepine which is being increasingly preferr above diazepam for procedures requiring conscious sedation as it is as endoscopy, dental procedures, and regional anesthesia. [4-8] Advantages of midazolam from one side of to the other diazepam include a rapid first brunt of action, [5,8] lack of pain and venous complications at injection site [568] and a greater amnestic meaning [5,6,9] We describe the use of intravenous midazolam in the setting of transthoracic electrical cardioversion.

METHOD

Twelve patients underwent elective electrocardioversion in accordance with standard protocol at The Memorial Hospital of Rhode Island. This protocol consists of obtaining informed compliance from the patient, discontinuation of digoxin therapy for at least 48 hours, ensuring normal values of electrolyte and ensuring adequate anticoagulation for at least couple weeks prior to cardioversion (in those without contraindications to anticoagulation). Deviation from the protocol is allowed if the situation is emergent or semiemergent, eg ventricular tachycardia, hemodynamically unstable supraventricular tachyarrhythmias. Cardioversion is carried abroad in the coronary care unit on or under the supervision of a cardiologist and an anesthesiologist. Patients routinely receive cheap flow (2 L/min) oxygen by dint of nasal canula prior to and folowing cardioversion. For the patients reported here, midazolam, 2 mg was initially administered intravenously athwart a period of two to four minutes. Subsequently it was administered intravenously at intervals of sum of two units to four minutes in 1 mg increments until the patient bring outed slurred speech and was not easily arousable according to verbal and physical stimuli. Vital signs were monitored constantly before and following cardioversion until they were stable and the patient was completely alert. Blood pressure was monitored with an automated recorded each two minutes until stable. Indications for cardioversion included atrial fibrillation, atrial move rapidly and hemodynamically stable ventricular tachycardia. Table 1 lists the characteristics of these patients. The 12 patients underwent a total of 17 cardioversions, with more [i]or[/i] less patients requiring more than the same cardioversion on separate occasions because of resort of arrhythmia. At each cardioversion attempt, serial clashs using higher energy levels were utilized, if lower energies failed to re-create the arrhythmia. Details are shown in Table 2 Statistical analysis was performed on the paired Student's t-test. issues were considered significant when p values were les than 005

RESULTS

Cardioversion with get back to normal sinus rhythm was achieved in 12 public of 17 procedures. Patients who remained in atrial fibrillation or beat [i]or[/i] move tremulously were maintained on medical regimen aimed at controlling the ventricular rate. Table 2 lists parameters recorded prior to and following cardioversion, dosages of midazolam used, and details of cardioversion.

Amnesia

relating to regaining full consciousness, patients were asked if they had any recollection of having undergone cardioversion. leave out for patient 9, all had total amnesia for the action Patient 9, who have undergone cardioversion using diazepam sedation forward two previous occasions, had cloyed memory of severe discomfort from prior cardioversions.

vital current Pressure

As shown in Figure 1 and Table 2 a transient mild pendant in systolic blood pressure was noted in about patients but none required a vasopressor or intravenous fluid convolution support. A few patients manifested transient rise in family pressure following cardioversion possibly related to enhanced adrenergic activity following cardioversion. As noted in Figure 1 and Table 2 values for systolic vital current pressures did not change significantly before and after midazolam administration.

Respirations

Respiratory status of each patient was monitored clinically until the patient had regained consciousness. There was a decline in the respiratory rate following midazolam treatment (postcardioversion) ranging from 0 to 8 from the baseline value prior to midazolam administration. Although this decline in respiratory rate was significant (p<00039) none of the patients, including the single in kind with the lowest recorded rate of 12/min, manifested any clinical evidence of respiratory distress requiring assisted ventilation. All patients received subdued flow oxygen, as noted earlier, as part of the protocol for cardioversion.

Recovery

The majority of patients regained well stocked [i]or[/i] provided consciousness spontaneously by one hour and all according to two hours. With the exception of common patient who experienced transient diplopia, no neurologic deficit was evident when patients became abundantly alert.

Dose of Midazolam