Scholarlink

Background <p>Guidelines recommend avoiding preoperative anxiolytic medication with midazolam. However, the risk–benefit ratio of preoperative midazolam prescriptions remains unclear. This study aimed to investigate the association between preoperative midazolam prescription and perioperative in-house mortality as well as preoperative cardiovascular stress.</p> Methods <p>We performed a retrospective single-center propensity score-matched study in a university hospital in Germany before and after de-implementation of routine oral preoperative midazolam prescription in December 2018. We included adult patients who underwent general anesthesia between December 1, 2017, and November 31, 2019. Patients who received midazolam premedication before de-implementation were compared to those who did not receive midazolam after de-implementation. After propensity score matching, we estimated the treatment effects using regression modeling. The primary endpoint was inhospital mortality after general surgery. Secondary endpoints included pre-induction vital signs, duration of stay in the postanesthesia care unit, and medications administered.</p> Results <p>After propensity score matching, we analyzed 7421 patients in each group. In this adjusted analysis, premedication with midazolam was not associated with mortality (<i>OR</i> 0.91, 95% <i>CI</i> 0.60 to 1.38, <i>p</i> = 0.662). Midazolam premedication was associated with significantly lower pre-induction blood pressures, with an estimated average treatment effect for systolic blood pressure of − 5.33&#xa0;mmHg (<i>SE</i> 0.41, 95% <i>CI</i> − 6.13 to − 4.52&#xa0;mmHg).</p> Conclusions <p>Midazolam prescription was not associated with increased mortality in a large cohort of surgical patients but with a lower pre-induction blood pressure and heart rate, suggesting a potential reduction in cardiovascular stress.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The omission of routine preoperative midazolam prescription is associated with increased preoperative sympathetic activation but not mortality: a propensity score matched, before-and-after study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年7月30日

查看全文
  • Carolin Jung,
  • Andre Gerdes,
  • Hans-Joerg Gillmann,
  • Thomas Stueber

摘要

Background

Guidelines recommend avoiding preoperative anxiolytic medication with midazolam. However, the risk–benefit ratio of preoperative midazolam prescriptions remains unclear. This study aimed to investigate the association between preoperative midazolam prescription and perioperative in-house mortality as well as preoperative cardiovascular stress.

Methods

We performed a retrospective single-center propensity score-matched study in a university hospital in Germany before and after de-implementation of routine oral preoperative midazolam prescription in December 2018. We included adult patients who underwent general anesthesia between December 1, 2017, and November 31, 2019. Patients who received midazolam premedication before de-implementation were compared to those who did not receive midazolam after de-implementation. After propensity score matching, we estimated the treatment effects using regression modeling. The primary endpoint was inhospital mortality after general surgery. Secondary endpoints included pre-induction vital signs, duration of stay in the postanesthesia care unit, and medications administered.

Results

After propensity score matching, we analyzed 7421 patients in each group. In this adjusted analysis, premedication with midazolam was not associated with mortality (OR 0.91, 95% CI 0.60 to 1.38, p = 0.662). Midazolam premedication was associated with significantly lower pre-induction blood pressures, with an estimated average treatment effect for systolic blood pressure of − 5.33 mmHg (SE 0.41, 95% CI − 6.13 to − 4.52 mmHg).

Conclusions

Midazolam prescription was not associated with increased mortality in a large cohort of surgical patients but with a lower pre-induction blood pressure and heart rate, suggesting a potential reduction in cardiovascular stress.