Patient-controlled premedication by iv midazolam for ambulatory surgery

Applying the principle and equipment of patient-controlled analgesia, this double-blind randomised study was designed to determine the premedication dose of midazolam and to provide information about the need for preoperative anxiety control. The effects of patient-controlled premedication by iv midazolam were compared to those of a 1-hour iv infusion of a fixed dose of 4 mg. Two groups of 25 patients were studied prior to ambulatory surgery. Using a visual analogue scale graded from 0 (no anxiety) to 100, anxiety and short-term memory as well as vital signs, vigilance, cognition and orientation were assessed before premedication and then every 20 min until admission to the operating room. In both groups, 40% of the patients were free of anxiety before premedication. Sixty-four percent of patients in the self-premedicated group never used the pump. The dose of midazolam was only 0.7 0.2 mg (mean SD) in this group taken as a whole, 0.7 1.1 mg (mean SD) in the 8 patients who had an anxiety score at least equal to 50 before premedication, and 1.7 0.3 mg (mean SD) in the 9 patients who chose to push the button of the patient-controlled device. Anxiety and short-term memory scores decreased significantly and similarly in the self-premedicated group and in the fixed-dose group. For similar intraoperative anaesthetic requirements, time from the end of anaesthesia for determining whether a patient was ready for admission to the postrecovery lounge was shorter in the self-premedicated group (26+/-8 min vs 32+/-8 min; mean+/-SD. Reduced doses of midazolam self-administered via a patient-controlled device can result in a relaxed preoperative period and amnesia in ambulatory surgery patients. However, the level of anxiety before premedication was low, which calls into question the legitimacy of the patient-controlled premedication in this kind of population. The expense of the pump was not justified by the small number of patients using it, probably because they were worried by the technical nature and the invasiveness of this technique.