Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results


2008 | 3 | 4 | 487-493

Article title

Sedation for middle ear surgery: prospective clinical trial comparing propofol and midazolam


Title variants

Languages of publication



During middle-ear-surgery under local anaesthesia (MES-LA), patients report hearing noises, feeling anxious, and experiencing earache. In a prospective randomized clinical trial, we compared propofol and midazolam for sedation in 68 patients scheduled for MES-LA. The starting dose of propofol was 1 to 1.5 mg per kilogram intravenously, followed by 1 to 2 mg per kilogram per hour given by infusion. The starting dose of midazolam was 0.02 to 0.05 mg per kilogram intravenously, followed by 0.01 to 0.02 mg per kilogram intravenously. Metamizol and fentanyl were added when required. Sedation was titrated to a Ramsay score of 3 to 4 and a bispectral index value of 70 to 80. Patients were assessed for vital parameters and sedation and pain scores. In the recovery room, readiness for discharge and satisfaction of both patient and surgeon with the procedure were assessed. The group receiving propofol had a significantly lower heart rate, shorter duration of sedation, and earlier readiness for discharge (p<0.05). There were no significant differences in other parameters evaluated. Seventy-nine per cent of patients in the group receiving propofol and 91.1% receiving midazolam would choose the same method of anaesthesia and sedation for any further MES-LA. Our results suggest that, compared to midazolam, propofol is more suitable for sedation in patients undergoing MES-LA. However, appropriate patient selection, adequate preparation, and careful monitoring are mandatory.










Physical description


1 - 12 - 2008
22 - 10 - 2008


  • Department of Anaesthetics and Surgical Intensive Care, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
  • Department of Anaesthetics and Surgical Intensive Care, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia


  • [1] Shambaugh G., Surgery of the ear, Philadelphia, London, WB Saunders, 1967
  • [2] Tos M., Manual of Middle Ear Surgery. Volume 1: Approaches, Myringoplasty, Ossiculoplasty and Tympanoplasty, Georg Thieme, 1993, 7–10
  • [3] Yung M.W., Local anaesthesia in middle ear surgery: survey of patients and surgeons, Clin. Otolaryngol., 1996, 21, 404–408 http://dx.doi.org/10.1046/j.1365-2273.1996.00814.x[Crossref]
  • [4] Niemann C., Gropper M.A., Pharmacology of Conscious Sedation, In: Wiener-Kronish J.P., Gropper M.A., Conscious Sedation, Philadelphia, Hanley&Belfus, 2001, 1–17
  • [5] Alexander J.A., Smith B.J., Midazolam sedation for percutaneous liver biopsy, Dig. Dis. Sci., 1993, 38(12), 2209–2211 http://dx.doi.org/10.1007/BF01299897[Crossref]
  • [6] Meining A., Semmler V., Kassem M., Sander R., Frankenberger V., Burzin M., et al., The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomised study comparing propofol with midazolam, Endoscopy, 2007, 39, 345–349 http://dx.doi.org/10.1055/s-2006-945195[Crossref][WoS]
  • [7] Crea F., Ruggiero A., Genovese O., Tortolo L., Zorzi G., Chiaretti A., Safety and efficacy of two protocols for sedation in pediatric oncology procedures, Cent. Eur. J. Med., 2008, 3(1), 77–82 http://dx.doi.org/10.2478/s11536-008-0001-6[WoS][Crossref]
  • [8] Caner G., Olgun L., Gültekin G., Aydar L., Local anesthesia for middle ear surgery, Otolaryngol. Head Neck Surg., 2005, 133(2), 295–297 http://dx.doi.org/10.1016/j.otohns.2004.09.112[Crossref]
  • [9] Vega Sepulveda R.A., Cabrera C., Schmied S., Bedoya E., Diaz-Valdes V., Dexmedetomidine: A new Alpha-2 Agonist Anesthetic Agent in Infusion for Sedation in Middle Ear Surgery with Awake Patient, Anesthesiology, 2005, 103, A623
  • [10] Singh H., Bispectral index (BIS) monitoring during propofol-induced sedation and anaesthesia, Eur. J. Anaesthesiol., 1999, 16(1), 31–36 http://dx.doi.org/10.1046/j.1365-2346.1999.00420.x[Crossref]
  • [11] Ramsay M.A.E., Savege T.M., Simpson B.R.J., Goodwin R., Controlled sedation with alpaxalone-alphadolone, Br. Med. J., 1974, 2, 656–659 [Crossref]
  • [12] Kelly A.M., The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain, Emerg. Med. J., 2001, 18, 205–207 http://dx.doi.org/10.1136/emj.18.3.205[Crossref]
  • [13] Aldrete J.A., The post-anesthesia recovery score revisited, J. Clin. Anesth., 1995, 7, 89–91 http://dx.doi.org/10.1016/0952-8180(94)00001-K[Crossref]
  • [14] Brasher P., Brandt R.F., Sample size calculations randomized trials: common pitfalls, Can. J. Anesth., 2007, 54(2), 103–106 http://dx.doi.org/10.1007/BF03022005[Crossref]
  • [15] Alhashemi J.A., Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery, Br. J. Anaesth., 2006, 96, 722–726 http://dx.doi.org/10.1093/bja/ael080[Crossref]
  • [16] White P.F., Negus J.B., Sedative infusions during local and regional anesthesia: a comparison of midazolam and propofol, J. Clin. Anesth., 1991, 3, 32–39 http://dx.doi.org/10.1016/0952-8180(91)90203-Y[Crossref]
  • [17] Hasen K.V., Samartzis D., Casas L.A., Mustoe T.A., An outcome study comparing intravenous sedation with midazolam / fentanyl (conscious sedation) versus propofol infusion (deep sedation) for aesthetic surgery, Plast. Reconstr. Surg., 2003, 112 (6), 1683–1689 http://dx.doi.org/10.1097/01.PRS.0000086363.34535.A4[Crossref]
  • [18] Parworth L.P., Frost D.E., Zuniga J.R., Bennet T., Propofol and fentanyl compared with midazolam and fentanyl during third molar surgery, J. Oral. Maxillofac. Surg., 1998, 56(4), 447–453 http://dx.doi.org/10.1016/S0278-2391(98)90710-8[Crossref]
  • [19] Shinozaki M., Usui Y., Yamaguchi S., Okuda Y., Kitajima T., Recovery of psychomotor function after propofol sedation is prolonged in the elderly, Can. J. Anesth., 2002, 49(9), 927–931 [Crossref]
  • [20] Horiguchi T., Nishikawa T., Heart Rate Response to Intravenous Atropine During Propofol Anesthesia, Anesth. Analg., 2002, 95, 389–392 http://dx.doi.org/10.1097/00000539-200208000-00027[Crossref]
  • [21] Ferguson D., Use of deep intravenous sedation with propofol and the laryngeal mask airway during transesophageal echocardiography, Journal of Cardiothoracic and Vascular Anesthesia, 2003, 17(4), 443–446 http://dx.doi.org/10.1016/S1053-0770(03)00147-2[Crossref]
  • [22] Ku Peter K.M., Tong Michael C.F., Lo P., van Hasselt C.A., Efficacy of Ondansetron for Prevention of Postoperative Nausea and Vomiting After Outpatient Ear Surgery Under Local Anesthesia, American Journal of Otology, 2000, 21(1), 24–27
  • [23] Girdler N.M., Fairbrother K.J., Lyne J.P., A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period, Br. Dent. J., 2002, 192, 335–339 http://dx.doi.org/10.1038/sj.bdj.4801369a[Crossref]

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.