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The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting: A Meta-Analysis

Grant, Michael C. MD; Kim, Jimin BS; Page, Andrew J. MD; Hobson, Deborah BSN; Wick, Elizabeth MD; Wu, Christopher L. MD

doi: 10.1213/ANE.0000000000000941
Ambulatory Anesthesiology and Perioperative Management: Research Report

BACKGROUND: Research has shown that high-risk surgical patients benefit from a multimodal therapeutic approach to prevent postoperative nausea and vomiting (PONV). Our group sought to investigate the effect of administering IV midazolam on PONV.

METHODS: This meta-analysis included 12 randomized controlled trials (n = 841) of adults undergoing a variety of surgical procedures that investigated the effect of both preoperative and intraoperative IV midazolam on PONV in patients undergoing general anesthesia.

RESULTS: Administration of IV midazolam was associated with significantly reduced PONV (risk ratio [RR] = 0.55; 95% confidence interval [CI], 0.43–0.70), nausea (RR = 0.62; 95% CI, 0.40–0.94), vomiting (RR = 0.61; 95% CI, 0.45–0.82), and rescue antiemetic administration (RR = 0.49; 95% CI, 0.37–0.65) within 24 hours. Individual subgroup analyses of trials excluding the use of thiopental for induction, trials of either female sex or high-risk surgery, trials involving nitrous oxide maintenance, and trials using midazolam in combination with known antiemetics all yielded similar reductions in PONV end points within 24 hours of surgery.

CONCLUSIONS: Administration of preoperative or intraoperative IV midazolam is associated with a significant decrease in overall PONV, nausea, vomiting, and rescue antiemetic use. Providers may consider the administration of IV midazolam as part of a multimodal approach in preventing PONV.

Published ahead of print September 1, 2015

From *Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Anesthesiology and Critical Care, University of Chicago, Chicago, Illinois; and Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.

Accepted for publication June 16, 2015.

Published ahead of print September 1, 2015

Funding: None.

The authors declare no conflict of interests.

Reprints will not be available from the authors.

Address correspondence to Michael C. Grant, MD, Department of Anesthesiology, Zayed 8120K A3, The Johns Hopkins Medical Institutions, 1800 Orleans St., Baltimore, MD 21287. Address e-mail to

© 2016 International Anesthesia Research Society