Midazolam is the sedative of choice to supplement narcotic anesthesia. Pro: Midazolam Is the Sedative of Choice to Supplement Narcotic Anesthesia

Mark Newman, J. G. Reves

Research output: Contribution to journalComment/debate

27 Scopus citations


Having examined the options for adjuvant drug use during cardiac anesthesia, it becomes increasingly apparent that midazolam is "the drug" of choice and that supplementation with an opioid is an ideal adjuvant. In the hands of experienced cardiac anesthesiologists, the majority of the drugs discussed could provide adequate anesthesia with outcomes that would be difficult to distinguish, with the exception of awakening and time to extubation. Regardless of the inability to differentiate overall outcome, when comparing ease of providing complete "balanced" anesthesia, minimal cost increase, ease of use, hemodynamic stability, reliability of amnesia and ability to decrease narcotic requirement and allow early extubation, midazolam is a clear winner. Given as a continuous infusion or a bolus, potent opioids such as alfentanil, fentanyl or sufentanil enhance the amnestic and hypnotic effect of midazolam, decreasing the required dose. In addition, the combination of midazolam and narcotics decreases the catecholamine response that either one alone would produce. This removes the necessity of marked narcotic overdose required when narcotics alone are used. The result of this anesthetic combination is a technique that can be used in the majority of cardiac patients regardless of their ventricular performance, allowing options for earlier awakening, earlier extubation and decreased ICU stay. The goal of complete "balanced" anestheisa is best achieved with continuous infusions of micazolam and opioids. Accepting recall of intraoperative events as a necessary evil is unacceptable in the stable cardiac surgery patient. Continous infusion of midazolam with narcotics reliably keeps patients unconscious, prevents recall, and provides a consistent, dependable hypnotic/amnestic foundation upon which opioid analgesia can be added to build a complete anesthetic.

Original languageEnglish
Pages (from-to)615-619
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number5
StatePublished - Oct 1993

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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