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*Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel; Departments of Anesthesiology, and Pharmacology, Medical University of Lübeck, Germany; and Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria
Address correspondence and reprint requests to Volker Dörges, MD, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, 24105 Kiel, Schwanenweg 21, Germany. Address e-mail to v.doerges{at}t-online.de
Patients in the emergency medical service (EMS) may have increased endogenous catecholamines because of pain or fear and may benefit from sedation similar to premedication in the hospital. During a simulated EMS scene call, 72 healthy male volunteers were either transported by paramedics from a third-floor apartment through a staircase with subsequent EMS transport with sirens (three stress groups of n = 12; total, n = 36) or asked to sit on a chair for 5 min and lie down on a stretcher for 15 min (three control groups of n = 12; total, n = 36). Catecholamine plasma samples were measured in the respective stress and control groups at baseline and after placebo IV (n = 12) or 25 (n = 12) or 50 (n = 12) µg/kg of midazolam IV throughout the experiment, respectively. Statistical analysis was performed with analysis of variance; P < 0.05 was considered significant. The Placebo Stress versus Control group, but not the 50 µg/kg Stress Midazolam group, had both significantly increased epinephrine (73 ± 5 pg/mL versus 45 ± 5 pg/mL; P < 0.001) and norepinephrine (398 ± 34 pg/mL versus 278 ± 23 pg/mL; P < 0.01) plasma levels after staircase transport. After EMS transport, the Placebo Stress versus Control group had significantly increased epinephrine (51 ± 4 pg/mL versus 37 ± 4 pg/mL; P < 0.05) but not norepinephrine (216 ± 24 pg/mL versus 237 ± 18 pg/mL) plasma levels, whereas no significant differences in catecholamine plasma levels occurred between groups after either 25 or 50 µg/kg of midazolam. In conclusion, simulated EMS patients may be subject to more stress during staircase transport than during transport in an EMS vehicle. Titrating sedation with 25 µg/kg of midazolam significantly reduced endogenous catecholamines but not heart rate.
IMPLICATIONS: Simulated emergency medical service patients were more likely to be stressed when being transported by paramedics through a staircase than in an ambulance. Accordingly, it may be beneficial to inject sedative drugs before initiating transport to ensure patient comfort and safety.
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  Midazolam Reduces the Stress of Ambulance Transport Journal Watch Emergency Medicine, October 29, 2002; 2002(1029): 11 - 11. [Full Text]
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