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Middle-ear surgery under sedation: comparison of midazolam alone or midazolam with remifentanil

  • J J Lee (a1) and J H Lee (a2)



Performance of middle-ear surgery under local anaesthesia has several advantages, but many patients complain of pain, anxiety and adverse events (e.g. dizziness and nausea). To minimise such problems, we compared sedation with midazolam alone versus midazolam with remifentanil.

Patients and methods:

We initially observed 19 patients undergoing middle-ear surgery under local anaesthesia, as controls. We then sedated a further 40 patients undergoing such surgery, with either midazolam or midazolam plus remifentanil.


The sedated patients had significantly lower incidences of local anaesthesia injection pain (p < 0.001), intra-operative pain (p < 0.001), intra-operative anxiety (p < 0.001) and adverse events, compared with the control group. Patients sedated with midazolam plus remifentanil reported less intra-operative anxiety (p = 0.010) and greater post-operative satisfaction with sedation (p = 0.007), compared with those sedated with midazolam only.


Patients undergoing middle-ear surgery under local anaesthesia alone frequently report pain, anxiety and adverse events. However, the majority of our patients who were sedated with midazolam satisfactorily overcame pain, anxiety and adverse events. Results were better still when midazolam was accompanied by remifentanil.


Corresponding author

Address for correspondence: Dr J H Lee, Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, #153, Kyo-Dong, Chuncheon, Gangwon, South Korea Fax: 82 33 241 2909 E-mail:


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1Lancer, JM, Fisch, U. Local anaesthesia for middle ear surgery. Clin Otolaryngol Allied Sci 1988;13:367–74
2Sarmento, KM Jr, Tomita, S. Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation. Acta Otolaryngol 2009;129:726–8
3Yung, MW. Local anaesthesia in middle ear surgery: survey of patients and surgeons. Clin Otolaryngol Allied Sci 1996;21:404–8
4Khanderia, U, Pandit, SK. Use of midazolam hydrochloride in anesthesia. Clin Pharm 1987;6:533–47
5Melvin, MA, Johnson, BH, Quasha, AL, Eger, El 3rd. Induction of anesthesia with midazolam decreases halothane MAC in humans. Anesthesiology 1982;57:238–41
6Avramov, MN, Smith, I, White, PF. Interactions between midazolam and remifentanil during monitored anesthesia care. Anesthesiology 1996;85:1283–9
7Gold, MI, Watkins, WD, Sung, YF, Yarmush, J, Chung, F, Uy, NT et al. Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care. Anesthesiology 1997;87:51–7
8Egan, TD, Lemmens, HJ, Fiset, P, Hermann, DJ, Muir, KT, Stanski, DR et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology 1993;79:881–92
9Glass, PS, Hardman, D, Kamiyama, Y, Quill, TJ, Marton, G, Donn, KH et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B). Anesth Analg 1993;77:1031–40
10Rosow, C. Remifentanil: a unique opioid analgesic. Anesthesiology 1993;79:875–6
11Liu, YH, Li, MJ, Wang, PC, Ho, ST, Chang, CF, Ho, CM et al. Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery. Laryngoscope 2001;111:1271–4
12Misra, MN, Pullani, AJ, Mohamed, ZU. Prevention of PONV by acustimulation with capsicum plaster is comparable to ondansetron after middle ear surgery. Can J Anaesth 2005;52:485–9
13Sanjay, OP, Tauro, DI. Midazolam: an effective antiemetic after cardiac surgery – a clinical trial. Anesth Analg 2004;99:339–43


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Middle-ear surgery under sedation: comparison of midazolam alone or midazolam with remifentanil

  • J J Lee (a1) and J H Lee (a2)


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