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

Objective: 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. Results: 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. Conclusion: 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.