Ventilatory effect of midazolam in deep sedation for hepatic tumor patients

What is it about?

Radiofrequency ablation (RFA) is an alternative technique for treatment of small hepatic tumors that cannot be managed with surgical treatment, because of its equivalent long-term survival, decreased morbidity, and better preservation of hepatic parenchyma. The mainly used sedoanalgesic drugs were propofol, fentanyl, and midazolam. However, midazolam can create hypoventilation or respiratory depression. Furthermore, previous reports demonstrated that the risk for adverse respiratory events increased with an increase in dose and is synergistically worsened by opioids and other anesthetic agents. The aim of the study was to compare the ventilatory effect between propofol deep sedation technique with and without midazolam in hepatic tumor patients undergoing radiofrequency ablation procedure.

Featured Image

Why is it important?

There were no significant differences in the patients’ characteristics, duration of the procedure, the total dose of propofol, ventilatory parameters including oxygen saturation, end-tidal carbon dioxide, and respiratory rate, as well as sedation score at 20, 25, 30, 35, and 40 min after the procedure, between the two groups. However, the mean sedation score at 5, 10, and 15 min after the procedure, in group B, was significantly lower than in group A. In addition, the duration of sleep after the procedure, in group B, was significantly greater than in group A. No serious ventilatory adverse effects were observed either group. A combination of low-dose midazolam with propofol and fentanyl for deep sedation in these patients does not create serious ventilatory adverse effects. Although, the mean sedation score at 5, 10, and 15 min after the procedure, as well as the mean duration of sleep, was statistically different between the two groups. However, they were not clinically significant. Our report of PDS practice for the percutaneous RFA procedure demonstrated that it could be managed safely with or without midazolam.

Perspectives