Table of Contents
ISRN Anesthesiology
Volume 2013, Article ID 202835, 7 pages
Review Article

Midazolam in Subarachnoid Block: Current Evidence

1Lilabati Hospital & Research Center, Mumbai 50, India
2Department of Anaesthesiology and Intensive Care, AIIMS, Ansari Nagar, New Delhi 29, India

Received 31 December 2012; Accepted 27 January 2013

Academic Editors: E. Freye and A. Mizutani

Copyright © 2013 Anirban Chattopadhyay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Midazolam, despite of being the commonest benzodiazepine used in anaesthesia and perioperative care, is a relatively newer addition to the list of adjuvant used in subarachnoid block. Midazolam causes spinally mediated analgesia and the segmental analgesia produced by intrathecal midazolam is mediated by the benzodiazepine-GABA receptor complex. Initial animal studies questioned the safety of intrathecal midazolam in terms of possible neurotoxicity. However subsequent clinical studies also failed to show any neurotoxicity of high dose midazolam even on long-term use. Addition of intrathecal midazolam to bupivacaine significantly improves the duration and quality of spinal anaesthesia and provides prolonged perioperative analgesia without any significant side effects. Clinical studies also reported its safety and efficacy in pregnant women, but some studies also reported mild sedation with intrathecal midazolam. It is also reported to decrease the incidence of PONV. Intrathecal midazolam does not have any clinically significant effect on perioperative hemodynamics.