• Mirko Mihalj, Zoran Karlović, Dajana Vladić-Spaić, Boris Matić, Iva Mikulić, Vinka Mikulić, and Vesna Golubović.
• Department for Anesthesia and Intensive Care, University Clinical Hospital Mostar, KraljaTvrtka bb, Mostar, Bosnia and Herzegovina.
• Medicine (Baltimore). 2022 Nov 11; 101 (45): e31400e31400.

BackgroundThis study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone.MethodsWe conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction.ResultsSAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001).Conclusion SubsectionsMidazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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