{"title":"咪达唑仑和谵妄:你能两者兼得吗?","authors":"R. Greengrass","doi":"10.1136/rapm-2022-103607","DOIUrl":null,"url":null,"abstract":"I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"118 1","pages":"449 - 450"},"PeriodicalIF":0.0000,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Midazolam and delirium: can you have it both ways?\",\"authors\":\"R. Greengrass\",\"doi\":\"10.1136/rapm-2022-103607\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.\",\"PeriodicalId\":21046,\"journal\":{\"name\":\"Regional Anesthesia & Pain Medicine\",\"volume\":\"118 1\",\"pages\":\"449 - 450\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-03-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Regional Anesthesia & Pain Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/rapm-2022-103607\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Regional Anesthesia & Pain Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/rapm-2022-103607","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Midazolam and delirium: can you have it both ways?
I read with interest the recent article by Mentsoudis et al regarding the risk/benefits of midazolam preoperatively in a total joint arthroplasty population. They reported no association of midazolam with delirium, a significantly decreased incidence of cardiac and pulmonary complications and an increased incidence of falls. In a previously published review using the same Premier Healthcare Database examining the same total joint population as the current article, the authors determined that patients receiving shortacting benzodiazepines had significantly lower risks of postoperative delirium. The lesser incidences of delirium may have been because of neuroprotection accorded by midazolam during periods of vascular embolization incurred by arthroplasty surgery. Indeed, cerebral protective effects from midazolam have been previously reported by Michenfelder and others. 4 In the current database analysis, the authors confirm that there is no increased risk of delirium from midazolam (and cite collateral investigations thus the long held view that midazolam results in increased incidences of delirium may be unfounded. Of interest in an article cited by some members of the ASA regarding inappropriate medication use in older adults, it is stated “all benzodiazepines increase risk of delirium”; however, midazolam is not mentioned in this article and no citations are listed to substantiate this statement. In the current article, the authors also determined a significantly decreased risk of pulmonary and cardiac complications in patients who received midazolam which leads to speculation of additive cardiac and pulmonary protective effects in this subset of patients. The possible association of increased falls is difficult to understand particularly with the knowledge of decreased delirium associated with midazolam administration and rapid dissolution of midazolam effect if only given preoperatively. The authors also determined that gabapentinoids when combined with midazolam increased sedationrelated complications which would be expected when adding any sedative agent. I concur with the authors that indiscriminate use of any drug, including midazolam, should be discouraged; however, the documented benefits of decreased delirium, and lesser pulmonary and cardiac complications in a total joint population should not preclude its use in this population of patients when indicated.