14 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Discussion (Part 3)

As a group, ventilated patients did not demonstrate major blood pressure variations or tachycardia. The mean decrease in systolic blood pressure below baseline values was 10 percent, which was related to sedation, and not to the bronchoscopic procedure. In normal humans, midazolam at a dose of 0.15 mg/kg IV produces a similar response, associated with an increase in heart rate and a decrease in systemic vascular resistance. In our study, definite hypotension was linked to premedication and to the severity of illness. The APACHE score, which is a classification system representing the degree of acute illness, and the relative hypotension before the procedure were the more appropriate of the 27 items included in the multivariate analysis. The use of PEEP or the requirement for inotropic agents was not a significant risk factor. During endoscopy, a significant rise in arterial pressure was observed (10 percent above control values), associated with an increase in pulse rate of 5 percent. Such observations have been observed in routine fiberoptic bronchoscopy using an intravenous anesthetic technique of intermittent thiopental (thiopentone) and succinylcholine (suxamethonium), but not in patients receiving either Fentanyl or alfentanil. It is unlikely that using higher doses of midazolam would have prevented such modifications in the rate-pressure product, which are consistent with those observed by Boralessa et al in intubated patients after a bolus of 0.3 mg/kg IV for induction of anesthesia. Therefore, alternative anesthetic protocols should be built up in order to minimize risks of cardiovascular impairment. Find most trusted pharmacy that will give you order alegra in the amounts required without any need for a prescription. You will see that shopping with a place you can already trust over and over again is very affordable and always nice.

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