Low-dose midazolam for anxiolysis for pregnant women undergoing cesarean delivery: a randomized trial
Baixas doses de midazolam para ansiólise de gestantes submetidas ao parto cesariano: um estudo randomizado
Pedro Solfa Campos Oliveira, Beatriz Cesar Sant’Anna, Náira Bueno Seixas, José Alexandre Mendonça
Abstract
Introduction
Anxiety and fear are common among pregnant women undergoing cesarean delivery. In addition to psychologically unpleasant, they can elicit endocrine and metabolic changes. Administration of benzodiazepines in this patient group is uncommon and investigation focusing on the topic is rare. This study aimed to determine anxiolysis efficacy of low-dose midazolam administered preoperatively, right before cesarean delivery, and to evaluate whether its administration impacts neonatal vitality, maternal consciousness and recall of the moment the baby was born.
Methods
Fifty pregnant women with indication for cesarean delivery were included in this randomized, double-blind, placebo-controlled clinical study and allocated into two groups of 25 participants each (Midazolam and Control group). Midazolam (0.0125 mg.kg-1) or a placebo solution was administered immediately before spinal anesthesia and the anxiolytic effect was assessed using a visual analogue scale before and after administration. We registered the Apgar score at 1 and 5-minutes, the Ramsay scale and recall of the moment of birth, that was assessed 90-minutes after birth.
Results
Pregnant women from the Midazolam group presented a 1.3-point reduction in anxiety on the visual analogue scale, while the Control group showed virtually no change (p = 0.027). We observed no statistically significant changes in Apgar scores, level of maternal consciousness and recall of the moment of delivery.
Conclusions
Low-dose midazolam can provide anxiety management in pregnant women undergoing cesarean delivery with no significant undesirable effects.
Keywords
Resumo
Justificativa: A ansiedade e o medo são sentimentos frequentes em gestantes submetidas ao parto cesariano. Tal sentimento, além de psicologicamente desagradável, pode promover alterações endocrinometabólicas. O uso de benzodiazepínicos nesse grupo de pacientes é infrequente e os estudos sobre o tema são escassos. Os objetivos deste estudo foram determinar a eficácia ansiolítica de baixas doses de midazolam no período pré-operatório imediato ao parto cesariano e avaliar se há interferência dessa conduta na vitalidade neonatal, no nível de consciência materno e na recordação do momento do nascimento. Métodos: Cinquenta gestantes (grupo Midazolam: 25; grupo Controle: 25) com indicação de parto cesariano foram incluídas neste estudo clínico randomizado, duplo-cego e placebo-controlado. Midazolam (0,0125 mg/kg) ou solução placebo foram administrados imediatamente antes da anestesia raquidiana e a ansiólise foi mensurada pela escala visual analógica antes e após a solução. Dados referentes ao índice de Apgar de 1º e 5º minutos, escala de Ramsay e recordação do momento do nascimento, verificada 90 minutos após a ocorrência, foram coletados. Resultados: Gestantes que receberam o midazolam tiveram redução da ansiedade em 1,3 pontos pela escala visual analógica, enquanto o grupo Controle praticamente não apresentou alteração (p = 0,027). Não houve alterações estatisticamente significativas nos índices de Apgar, no nível de consciência materna e na recordação do momento do parto. Conclusões: Baixas doses de midazolam podem ser utilizadas para o controle da ansiedade de gestantes submetidas ao parto cesariano sem promover efeitos indesejados significativos.
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References
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