• Pasquale Notarstefano, Claudio Pratola, Tiziano Toselli, Elisa Baldo, and Roberto Ferrari.
• University of Ferrara, Cardiovascular Institute, Ferrara, Italy. notarstefano2001@yahoo.it
• Pacing Clin Electrophysiol. 2007 May 1; 30 (5): 608-11.

BackgroundElectrical cardioversion (ECV) usually requires the assistance of the anesthesiology team. To avoid this dependence, previous studies have considered the use of sedation with benzodiazepines administered by cardiologists. We describe our experience with intravenous Midazolam during cardioversion.MethodsWe performed 280 ECV in 202 patients sedated with intravenous Midazolam, without anesthesiology supervision. In scheduled cardioversions, we tested two protocols of Midazolam administration: a bolus of 3 mg, followed by 2 mg each minute until necessary, and a loading dose of 0.09-0.1 mg/kg. In cardioversions performed during electrophysiology studies or defibrillator implant, Midazolam was administered by small repeated doses during the entire procedure.ResultsMidazolam was effective to obtain adequate sedation in 99% of cases. All patients had amnesia with regards of the cardioversion. A loading dose of Midazolam allowed a shortening of the procedural time without serious adverse events. Intubation or the assistance of an anesthetist was never necessary.ConclusionSedation with Midazolam for ECV is effective and well tolerated, with some cautions discussed. A loading dose of Midazolam is well tolerated and further reduces the procedural time.

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