Midazolam with and without background dose of patient-controlled sedation during percutaneous transluminal coronary angioplasty and stenting

YANG Gai-sheng; CHEN Yan-ying; XUE Xiao-dong

Abstract：ObjectiveWe aimed to observe the safety and effect of patient-controlled sedation(PCS) with midazolam during transluminal percutaneous coronary angioplasty (PTCA) and stenting (CS).MethodsSixty patients of coronary heart disease (heart function testsⅠ~Ⅱ) were randomly divided into three groups: group A (Midazolam continuous dose 0.1 mg/(kg·h)+0.25 mg bolus,3-minute lockout,n=20) and group B (Midazolam 0.5 mg bolus only,3-minute lockout,n=20) and group C(control group without any Sedated therapy,n=20).Neither group A nor group B has loading dose. Heart rates, blood pressure and oxygen saturation were continuously monitored. Level of sedation were scored, Bispectral Idex(BIS), ACTH and Catecholamine in blood plasma are monitoring in all patients before, during and 3h after the operation. Patients’satisfaction was assessed by questionnaire.ResultsThere were no significant changes of heart rates, blood pressure, oxygen saturation, RPP, level of sedation, BIS, ACTH and catecholamine in blood plasma in all patients before the operation. Heart rates, blood pressure and oxygen saturation in group A decreased more significantly than that in group C during operation(P<0.01), heart rates, blood pressure in group B decreased more dramatically than that in group C(P<0.05) but oxygen saturation were similar in group B and group C. The level of sedation was higher, and BIS was lower in group A and group B than that in group C(P<0.05).The levels of ACTH and catecholamine in group A and group B were lower than that in group C (P<0.05).There are no significance changes of the level of ACTH and catecholamine between group A and group B. Two patients became over-sedated in group A, compared with none in group B.ConclusionPatient-controlled sedation with midazolam (bolus only) may provide safe and effective sedation during percutaneous transluminal coronary angioplasty and stenting, and reduce the level of stress response.