Application of midazolam intravenous anesthesia in interventional embolization of intracranial aneurysms
Zhang Tongjun
Sun Xuefei
Jin Hongxu
Wang Fuchao
Wang Zhongyi
Liu Zhiyong
Abstract：Objective To investigate the effect of the total intravenous anesthesia(TIVA) with midazolam for the interventional embolization of intracranial aneurysm.Methods Forty patients who were about to receive scheduled interventional embolization of intracranial aneurysm were randomly assigned into two groups:midazolam group (total intravenous anesthesia with midazolam,n =20)and group C (general anesthesia with inhale and intravenous drugs,n =20).Anesthesia was inducted in the midazolam group with midazolam 0.3 mg/kg,sufentanil 0.3 μg/kg,rocuranium 0.6 mg/kg; in group C anesthesia was induced with propofol 1.5 mg/kg,respectively.When the depth of anesthesia was enough then inserted laryngeal mask mechanical ventilatior.Maintenance of anesthesia:in the midazolam group patients were infused with midazolam 0.1-0.2 mg/(kg · h),remifentanil 0.2-0.4 μg/(kg · h)and rocuranium 0.15 mg/(kg · h).In group C,the patients received inhaled sevoflurane with inspired concentration of 1％-3％ via breathing circuit and continuous infusion of remifentanil 0.2-0.4 μg/ (kg · min),rocuranium 0.15 mg/(kg · h).At the end of the operation,neostignine 2 mg and atropine 1 mg were gave to patients in both groups intravenously.Furthermore midazolam group gave flumazenil 1 mg intrrvenously.In group C,adjudst the flow of fresh gas larger than 6 L/min.Hemodynamic change was recorded at the time of before induction(T0),1 minute before insertion of laryngeal mask(T1),insertion of laryngeal mask(T2) puncture of the femoral artery(T3) embolization of the aneurysm(T4),extraction of the laryngeal mask(T5),and 10 minutes after the extubation(T6).And the time needed of the return of spontaneous respiration,recovery of the consciousness and extraction of the laryngeal mask(T6)were recorded.Results The mean arterial pressure (MAP) and heart rate decreased significantly compared with T0 to T1-T4 in each group [midazolam group (78 ± 10),(76 ± 13),(77 ±9),(79±11)mmHgvs (97±11)mmHg;(71±6),(69±5),(70±9),(72±10)times/minvs (83±10)times/min; group C(70 ± 12),(73 ± 12),(73 ± 15),(72 ± 12) mmHg vs (98 ± 10)mmHg; (69 ±9),(70 ±6),(70 ±8),(71 ± 5) times/min vs (80 ± 9) times/min] (P ＜ 0.05).There were no significant differences among T5,T6 and T0.MAP was increased in midazolam group when compared to group C at T1 [(78 ± 10) mmHg vs (70 ±12) mmHg] (P ＜ 0.05),but heart rate change had no significant difference.The time needed to return spontaneous respiration had no difference in two groups.But the time of recovery consciousness,extubating the laryngeal mask and reaching the level of consciousness score at 6 in midazolam group was significantly shorter than group C [(2.9±0.6)minvs (7.1 ±1.3)min,(4.1 ±1.2)min vs (12.7 ±2.2)min,(6.1 ±1.4)min vs (15.3 ± 3.1)min] (P ＜ 0.05).The alertness score after laryngeal mask extubation in midazolam group was lower than that in group C [(0.3 ± 0.1) scores vs (0.6 ± 0.1) scores] (P ＜ 0.05).Conclusion The application of the TIVA with midazolam for the Interventional embolization of intracranial aneurysm has good hemodynamic stability,excellent controllability,and the patients can quickly and safely wake up from anesthesia.
Keywords：Intracranial aneurysmsMidazolamInterventional therapyFlumazenil
Publication Date：2014-01-30
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：4( 47-50 )