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The effect of midazolam on visual paired-associate learning. A A schematic of the two parts of the visual paired-associate learning task consisting of (a) an encoding task, and (b) a cued recall task. B The effect of midazolam on encoding and retrieval of new information after drug administration. Individuals with intravenous midazolam showed a marked decrease in encoding and retrieval trials than subjects with saline. The hippocampus and prefrontal cortex were involved in paired-associate learning and midazolam significantly decreased the activation of hippocampus and prefrontal cortex in trials requiring encoding and retrieval of new information
Source publication
As a commonly used anesthetic agent, midazolam has the properties of water-soluble, rapid onset, and short duration of action. With the rapid development in the field of neuroimaging, numerous studies have investigated how midazolam acts on the human brain to induce the alteration of consciousness. However, the neural bases of midazolam-induced sed...
Citations
... Among general anesthetics, propofol, midazolam, etomidate, and ketamine are widely used for intravenous anesthesia [14][15][16], and desflurane, isoflurane, and sevoflurane are currently used for inhalation anesthesia [17]. Studies investigating the cognitive effects of individual anesthetic agents have been conducted primarily in animal models [18][19][20][21][22], with some studies measuring cognitive changes occurring from hours to days following surgery. ...
... It is primarily used for preoperative sedation and the induction of general anesthesia. Midazolam acts on GABA-A receptors to decrease neuronal excitability, resulting in the impairment of multidomain cognitive function immediately after dosing [15]. Although a recent meta-analysis has shown an association between long-term benzodiazepine use and cognitive decline [38], few studies have examined the long-term cognitive effects of a single dose of midazolam. ...
... Resting-state fMRI (rs-fMRI) can track changes in brain networks related to pharmacologically induced modulations [15,16]. Administering chloral hydrate, dexmedetomidine and propofol revealed decreases in connection density and efficiency in wholebrain networks during anaesthesia in rs-fMRI [17][18][19]. ...
... Within the default network reduced functional connectivity in the posterior cingulate cortex was reported during sedation [25]. A review of midazolam effects summarized that altered consciousness with midazolam is, in general, accompanied by decreased cerebral blood flow in the thalami and in precuneus regions [15]. Moreover, it is hypothesized that sedation with midazolam mainly alters functional connectivity in higher-order brain areas while areas concerned with primary sensory functions tend to remain unaffected, or even display elevated within-network connectivity [22]. ...
... A recent review on midazolam [15] pointed out that lower level sensory networks show elevated activity levels under weak sedation, what is backed by the observed increase in local connectivity in sensory networks in our study. Analyzing lowfrequency fluctuations we found a tendency of increased fALLF values in regions where we detected increased ReHo related to the administration of alprazolam (see Figs. S11, S12, and S13). ...
TSPO ligands are promising alternatives to benzodiazepines in the treatment of anxiety, as they display less pronounced side effects such as sedation, cognitive impairment, tolerance development and abuse potential. In a randomized double-blind repeated-measures study we compare a benzodiazepine (alprazolam) to a TSPO ligand (etifoxine) by assessing side effects and acquiring resting-state fMRI data from 34 healthy participants after 5 days of taking alprazolam, etifoxine or a placebo. To study the effects of the pharmacological interventions in fMRI in detail and across different scales, we combine in our study complementary analysis strategies related to whole-brain functional network connectivity, local connectivity analysis expressed in regional homogeneity, fluctuations in low-frequency BOLD amplitudes and coherency of independent resting-state networks. Participants reported considerable adverse effects such as fatigue, sleepiness and concentration impairments, related to the administration of alprazolam compared to placebo. In resting-state fMRI we found a significant decrease in functional connection density, network efficiency and a decrease in the networks rich-club coefficient related to alprazolam. While observing a general decrease in regional homogeneity in high-level brain networks in the alprazolam condition, we simultaneously could detect an increase in regional homogeneity and resting-state network coherence in low-level sensory regions. Further we found a general increase in the low-frequency compartment of the BOLD signal. In the etifoxine condition, participants did not report any significant side effects compared to the placebo, and we did not observe any corresponding modulations in our fMRI metrics. Our results are consistent with the idea that sedation globally disconnects low-level functional networks, but simultaneously increases their within-connectivity. Further, our results point towards the potential of TSPO ligands in the treatment of anxiety and depression.
... 7 Importantly, sedative action of midazolam doesn't compromise airway reß exes, induce signiÞ cant autonomic, hormonal, or circulatory changes, and is associated with anterograde amnesic properties. 8 This present study aimed to compare the effects of intrathecal midazolam combined with bupivacaine against bupivacaine alone for spinal anesthesia in infraumbilical surgeries. The study encompassed 50 patients aged 18 to 60 years, falling under ASA I/II category. ...
Context: Neuraxial anesthesia is the preferred choice for infraumbilical surgeries due to its advantages. The incorporation of midazolam alongside local anesthetic drugs in spinal anesthesia has demonstrated positive outcomes. This study was undertaken to assess the effectiveness of midazolam in terms of analgesic and anesthetic efficacy, as well as potential adverse effects, in patients undergoing infraumbilical surgeries. Aims: To compare the analgesic and anaesthetic effect of mixture of midazolam - bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgeries under spinal anaesthesia. Settings and Design: The present study is a prospective, observational study. Methods and Material: Fifty patients posted for elective infra-umbilical surgery were randomly divided into two groups of 25 each for intrathecal drug administration. (n=25). After administration of block, patients were assessed for analgesic and anesthetic effect of the drug. Statistical Analysis used: The study analyzed through the statistical programming software SPSS-22 and it involved the application of the student’s t-test, with a significance threshold set at a P value of <0.05. Results: Analgesic duration of patients in Midazolam Group was signiÞcantly longer compared to Bupivacaine Group for sensory block. More patients in the midazolam group were sedated and easily arousable. Conclusions: This study concludes that the addition of intrathecal preservative-free midazolam to hyperbaric bupivacaine improved intra - operative anaesthesia and prolonged duration of analgesia. Also, it was observed that there was a significant reduction in the consumption of analgesics during the postoperative period in patients undergoing infra-umbilical surgeries without causing any significant haemodynamic changes.
... When considering its application to the study of mind blanking, the sedative and amnesic effects of midazolam might also be of particular interest (see Wang et al. (2020). Given that mind blanking is a state where individuals are not consciously attending to external stimuli or internal thoughts, the sedative properties of midazolam might induce a similar state. ...
Mind blanking is a mental state in which attention does not bring any perceptual input into conscious awareness. As this state is still largely unexplored, we suggest that a comprehensive understanding of mind blanking can be achieved through a multifaceted approach combining self‐assessment methods, neuroimaging and neuromodulation. In this article, we explain how electroencephalography and transcranial magnetic stimulation could be combined to help determine whether mind blanking is associated with a lack of mental content or a lack of linguistically or conceptually determinable mental content. We also question whether mind blanking occurs spontaneously or intentionally and whether these two forms are instantiated by the same or different neural correlates.
... These substances alter consciousness and cognitive processes, allowing researchers to examine their effects on the occurrence and experience of mind blanking. By combining subjective reports with When considering its application to the study of mind blanking, the sedative and amnesic effects of midazolam might also be of particular interest (see Wang, Sun, and Liang (2020). ...
Mind blanking is a mental state in which attention does not bring any perceptual input into conscious awareness. As this state is still largely unexplored, we suggest that a comprehensive understanding of mind blanking can be achieved through a multifaceted approach combining self-assessment methods, neuroimaging, and neuromodulation. In this article, we explain how EEG and TMS could be combined to help determine whether mind blanking is associated with a lack of mental content or a lack of linguistically or conceptually determinable mental content. We also question whether mind blanking occurs spontaneously or intentionally and whether these two forms are instantiated by the same or different neural correlates.
... General anesthetic agents are commonly used to facilitate pediatric MRI investigations. However, they cause small alterations in brain hemodynamics, particularly midazolam induces a general reduction of CBF (Wang et al., 2020). Nonetheless, the use of sedation cannot explain the group differences observed in the present study, as Midazolam was administered to all newborns. ...
In preterm (PT) infants, regional cerebral blood flow (CBF) disturbances may predispose to abnormal brain maturation even without overt brain injury. Therefore, it would be informative to determine the spatial distribution of grey matter (GM) CBF in PT and full-term (FT) newborns at term-equivalent age (TEA) and to assess the relationship between the features of the CBF pattern and both prematurity and prematurity-related brain lesions. In this prospective study, we obtained measures of CBF in 66 PT (51 without and 15 with prematurity-related brain lesions) and 38 FT newborns through pseudo-continuous arterial spin labeling (pCASL) MRI acquired at TEA. The pattern of GM CBF was characterized by combining an atlas-based automated segmentation of structural MRI with spatial normalization and hierarchical clustering. The effects of gestational age (GA) at birth and brain injury on the CBF pattern were investigated. We identified 4 physiologically-derived clusters of brain regions that were labeled Fronto-Temporal, Parieto-Occipital, Insular-Deep GM (DGM) and Sensorimotor, from the least to the most perfused. We demonstrated that GM perfusion was associated with GA at birth in the Fronto-Temporal and Sensorimotor clusters, positively and negatively, respectively. Moreover, the presence of periventricular leukomalacia was associated with significantly increased Fronto-Temporal GM perfusion and decreased Insular-DGM perfusion, while the presence of germinal matrix hemorrhage appeared to mildly decrease the Insular-DGM perfusion. Prematurity and prematurity-related brain injury heterogeneously affect brain perfusion. ASL MRI may, therefore, have strong potential as a noninvasive tool for the accurate stratification of individuals at risk of domain-specific impairment.
... Poluvreme eliminacije je 1-4 sata, a može biti i produženo kod starijih pacijenata. Mentalna funkcija se obično vraća u normalu 4 sata nakon primene 17,18 . Neki lekovi i hrana produžavaju dejstvo oralno datog midazolama (kalcijumski blokatori, eritromicin, sok grejpfruta), dok suprotno dejstvo pokazuju rifampicin, kortikosteroidi, antikonvulzivi, barbiturati. ...
Preoperative medication or premedication is the administration of medications before surgery, to reduce anxiety, which is common in these patients, and as prophylaxis of side effects of anesthesia like heart rhythm disorders, blood pressure variations, hypersalivation, etc. Benzodiazepines are the usual agents used in premedication to provide relief of anxiety, anterograde amnesia, and light sedation. The most common benzodiazepines used for premedication are midazolam, Diazepam and lorazepam. They are usually given intramuscularly or orally in children. The time of use should be correlated with the moment of maximum effect depending on the method of administration. Time varies from twenty minutes for intramuscularly administered midazolam to two hours for peroral administered lorazepam. The choice of a particular Benzodiazepine, used for premedication, depends on its effects, duration of action, active metabolites, and side effects. The dose should be carefully tailored to provide the expected reduction of anxiety and light sedation and to avoid sleep and especially respiratory depression.
... Midazolam (MID) has anticonvulsant, anxiolytic, sedative, hypnotic, amnesic and muscle relaxant properties (Wang et al. 2020). Its affinity for benzodiazepines receptors in central nervous system is approximately twice as compared to diazepam. ...
Adequate sedation and excellent depth of analgesia were recorded in all the four groups after induction to the end of surgical procedure, however, significantly higher sedation score and depth of analgesia were observed in group D and significantly lower was observed in group A in comparison to other groups. Butorphanol with acepromazine, midazolam, or dexmedetomidine provides adequate sedation and analgesia in the dogs, before induction with propofol, so it made handling of the animals proper and safe before induction. Dexmedetomidine produces most profound sedation and analgesia followed by midazolam and acepromazine along with butorphanol.
... Dexamethasone can act as an antiemetic and treats shortness of breath [21]. Midazolam is used as an anxiolytic and causes temporary memory loss [22,23]. Metoclopramide is an antiemetic drug; therefore, it is primarily used to treat nausea and vomiting and to facilitate gastric evacuation in patients with gastroparesis [24]. ...
Background
Premedication is used prior to surgery to reduce the adverse effects that might result from general anesthesia.
Objective
This study was performed to examine the types and utility of various pre-anesthetic agents in 100 patients aged between 3 and 60 years who were admitted to Baladrooz General Hospital for different surgical operations during February (winter) and April (spring) 2021.
Methods
A total of 62 patients received isoflurane, and 7 patients received sevoflurane, both by inhalational administration. The other 31 subjects were administered Marcaine (bupivacaine) by spinal anesthesia.
Results
In this study, eight types of pre-anesthetic medication were administered prior to anesthesia, as follows: hydrocortisone (35 patients), metoclopramide (25 patients), atropine (13 patients), dexamethasone (12 patients), midazolam (7 patients), morphine (3 patients), ephedrine (3 patients), and fentanyl (2 patients). The most commonly used pre-anesthetic agent administered with isoflurane was hydrocortisone (37 patients), while the least used were fentanyl and morphine, which were administered to 3 patients each. Hydrocortisone was the premedication most often used (6 patients) with isoflurane, followed by dexamethasone, midazolam, and metoclopramide (5, 2, and 2 patients, respectively).The pre-anesthetic agent used most often with sevoflurane was hydrocortisone (6 patients), followed by dexamethasone (5 patients) and metoclopramide and midazolam (2 patients each). The premedication most commonly used with bupivacaine was metoclopramide (25 patients), while the least used was midazolam (2 patients).
Conclusion
The study showed that several different pre-anesthetic drugs were used prior to anesthetic agents, which suggests that selection of a pre-anesthetic drug depends on the risks that might be incurred when using a specific anesthetic drug.
... Considering that the onset of action of ketamine is around 5 min [37] and that of midazolam is 10 min [38], it is possible that the child was not yet under the sedative's effect. Moreover, neuroimaging studies have reported that midazolam and ketamine differently affect brain functional connectivity related to children's cognitive abilities while sedated [39,40]. Post-encoding stress can also impact functional connectivity and memory performance [41]. ...
The incidence of peri-procedural amnesia following procedural sedation in children is unclear and difficult to determine. This study aimed to apply quantitative and qualitative approaches to better understand amnesia following dental sedation of children. After Institutional Review Board Approval, children scheduled for sedation for dental procedures with oral midazolam (OM), oral midazolam and ketamine (OMK), or intranasal midazolam and ketamine (IMK) were recruited for examination of peri-procedural amnesia. Amnesia during the dental session was assessed using a three-stage method, using identification of pictures and an animal toy. On the day following the sedation, primary caregivers answered two questions about their children’s memory. One week later, the children received a semi-structured interview. Behavior and level of sedation during the dental session were recorded. Quantitative data were analyzed using descriptive statistics and comparison tests. Qualitative data were analyzed using content analysis. Triangulation was used. Thirty-five children (age: 36 to 76 months) participated in the quantitative analysis. Most children showed amnesia for the dental procedure (82.9%, n = 29/35) and remembered receiving the sedation (82.1%, n = 23/28 for oral administration; 59.3%, n = 16/27 for intranasal administration). The occurrence of amnesia for the dental procedure was slightly higher in the oral midazolam group compared with the other groups (44.8%, n = 13/29 for OM, 13.8%, n = 4/29 for OMK, and 41.4%, n = 12/29 for IMK). Twenty-eight children participated in the qualitative approach. The major theme identified was that some children could remember their procedures in detail. We conclude that peri-procedural amnesia of the dental procedure was common following sedation.
