Midazolam for induction of anaesthesia in patients with limited cardiac reserves. A comparison with etomidate.

The new water-soluble benzodiazepine, midazolam (Dormicum; Roche), was compared with etomidate as part of a balanced technique for induction of anaesthesia in 16 patients undergoing cardiac valve replacement. Monitoring revealed a significantly greater fall in blood pressure in patients receiving midazolam (reaching dangerous levels in 2 patients), which suggests that this agent is not suitable for induction of anaesthesia in haemodynamically compromised patients.

Development of malignant hyperthermia obscured by cardiopulmonary bypass.

An episode of malignant hyperthermia occurring in a two-year-old child undergoing cardiac surgery is reported. The coincidental usage of hypothermic cardiopulmonary bypass obscured the classical presenting signs and symptoms of the syndrome. Once the clinical diagnosis was confirmed, rapid reversal was achieved with the administration of dantrolene sodium.