Using Midazolam for Sedation and Premedication

Midazolam, a benzodiazepine, is currently the drug most commonly used to  reduce preoperative anxiety and induce sedation. It can be administered intravenously and orally. In adults, it can be used to control preoperative anxiety and, during a procedure alone or in combination with other drugs, for intravenous sedation. For children, oral midazolam in doses as small as 0.25 mg/kg

produces effective sedation and reduces anxiety. With this dose, most children can be effectively separated from their parents after 10 minutes and satisfactory sedation can be maintained for 45 minutes. Some children, particularly younger and more anxious children, even when they receive midazolam 0.5 mg/kg, show signs of distress. Discharge may be delayed when midazolam is given before a short procedure. Oral diazepam is useful to ..... click to read full text

When do you use pacemaker for myocardial infarction?

Resuming sex after a heart attack

After a heart attack or revascularization procedure, many people wonder whether it will be safe to resume sexual activity, and if so, when. They may worry about having another heart attack, or about dying during intercourse. If they have had bypass surgery, they may worry that sexual activity might be painful. Despite the importance of sex in a healthy relationship, many people (including doctors) are uncomfortable discussing it. As a result, questions go unasked, and information is not volunteered. The whole issue becomes the elephant in the room.
The American Heart Association (AHA) felt that evidence-based recommendations .....

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What the most accurate test is: creatine kinase-MB or troponin?

Creatine kinase-MB (CK-MB) is a form of an enzyme found primarily in heart muscle cells.




Your body makes 3 forms of CK, including CK-MB.





  • CK-MM (found in skeletal muscles and the heart)

  • CK-MB (found mostly in the heart, but small amounts found in skeletal muscles)

  • CK-BB (found mostly in the brain and smooth muscle, such as the intestines.

Physical tests for noncardiac chest pain.

Non-cardiac chest pain is a major problem in general practice, in outpatients, and on the wards. Some patients are “reassured” that their pain is not cardiac but this is of course not the end of the matter. Some are given the label “musculoskeletal” but this is not very convincing without a clear explanation.


  Coronary disease and inflammatory spinal disease can co-exist and this physical sign does not exclude angina but its presence in the absence of any objective evidence of myocardial ischaemia—for example, no ECG changes during pain, is helpful in the differential diagnosis... 



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