Efek Infus Midazolam Intraoperatif Pada Variabilitas Tekanan Darah Dan Kejadian Hipertensi Intraoperatif Pada Pasien Hipertensi

Q: What is the clinical evidence from this study?

Study design: Review. Population: Hypertension (n=10). Intervention: Intraoperative midazolam infusion vs. Other sedative agents (propofol, etomidate, remimazolam, dexmedetomidine) or placebo. Primary outcome: Hemodynamic stability, blood pressure variability, and intraoperative hypertension.

Q: What does this research mean for the field?

Intraoperative midazolam produces milder blood pressure reduction than propofol but less hemodynamic stability than etomidate, with currently limited evidence regarding its efficacy in reducing blood pressure variability or preventing intraoperative hypertension in hypertensive patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rinta Ramadhani; Angelina Najoan; Nurul Azzah; Galang Ramadhan; Ratih Kusumadewi

doi:10.71282/jurmie.v2i12.1487

December 31, 2025Jurnal Riset Multidisiplin EdukasiOpen Access

Efek Infus Midazolam Intraoperatif Pada Variabilitas Tekanan Darah Dan Kejadian Hipertensi Intraoperatif Pada Pasien Hipertensi

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Key result

Midazolam lowers blood pressure less than propofol but offers less hemodynamic stability than other sedatives.

n=10

Why the study?

The effects of intraoperative midazolam infusion on blood pressure variability and intraoperative hypertension in hypertensive patients are not fully understood.

Does intraoperative midazolam infusion improve blood pressure variability and prevent intraoperative hypertension in hypertensive patients?

Key Points

Summarize current evidence regarding the effects of intraoperative midazolam infusion on blood pressure variability and intraoperative hypertension in hypertensive surgical patients, while identifying key research gaps.
Conducted a scoping review adhering to PRISMA-ScR guidelines across PubMed, Google Scholar, and ClinicalTrials for publications between 2021 and 2025.
Screened randomized controlled trials, quasi-experimental, cohort, and observational studies evaluating intraoperative hemodynamic parameters.
Assessed methodological quality across 10 eligible studies using the Mixed Methods Appraisal Tool (MMAT) 2018.
Midazolam caused a milder decrease in blood pressure than propofol but conferred less hemodynamic stability than etomidate across evaluated trials.
Alternative sedative agents, notably remimazolam and dexmedetomidine, consistently demonstrated superior hemodynamic profiles and fewer blood pressure fluctuations compared with midazolam.
Intraoperative hypertension and blood pressure variability were repeatedly associated with heightened risks of postoperative acute kidney injury and organ dysfunction, but comprehensive statistical evaluations of variability remain scarce.

Structured PICO

Does intraoperative midazolam infusion improve blood pressure variability and prevent intraoperative hypertension in hypertensive patients?

P

Population

A scoping review of 10 studies evaluating the effects of intraoperative midazolam infusion on blood pressure variability and intraoperative hypertension in hypertensive patients.

I

Intervention

Intraoperative midazolam infusion (used for sedation, induction, or co-induction of anesthesia).

C

Comparator

Other sedative or anesthetic agents (including propofol, etomidate, remimazolam, dexmedetomidine, melatonin) or placebo.

O

Outcome

Intraoperative hemodynamic stability, specifically blood pressure variability (BPV) and intraoperative hypertension (IOH).surrogate

Intraoperative midazolam infusion may help maintain hemodynamic stability by reducing stress responses, but evidence for its effectiveness in reducing blood pressure variability and preventing intraoperative hypertension remains limited compared to newer agents like remimazolam and dexmedetomidine.

Limitations

Most studies did not evaluate blood pressure variability using comprehensive statistical methods.
Limited evidence directly assessing the impact of midazolam infusion on blood pressure variability in hypertensive patients.
Limitations in reporting randomization and blinding details in included RCTs.
Non-randomized studies lack the ability to ensure causal relationships due to confounding variables.
Most studies evaluated blood pressure at specific time points rather than using comprehensive statistical methods for blood pressure variability (BPV).
Limitations in reporting details of randomization and blinding in the included RCTs.
Non-randomized studies lacked the ability to confirm causal relationships due to limited control of confounding variables.

Implication

May warrant caution versus newer agents for stability in hypertensive patients; leaves open midazolam's role in reducing blood pressure variability.

Abstract

Background: Effective blood pressure control during surgery is crucial, especially for patients with hypertension, as blood pressure variability (BPV) and intraoperative hypertension (IOH) increase the risk of postoperative complications such as acute kidney injury (AKI). Midazolam is widely used for sedation, induction, and co-induction of anesthesia, but its effects on intraoperative hemodynamic stability particularly BPV and IOH in hypertensive patients are not fully understood. Objective: This scoping review summarizes current evidence on the effects of intraoperative midazolam infusion on BPV and IOH in hypertensive patients and identifies existing research gaps .Methods: A scoping review was conducted following PRISMA-ScR guidelines. Literature searches were performed in PubMed, Google Scholar, and ClinicalTrials for studies published between 2021 and 2025 with RCT, quasi-experimental, cohort, or observational designs reporting intraoperative hemodynamic parameters. Study quality was assessed using the MMAT 2018. Results: Ten studies met the inclusion criteria. Midazolam caused a milder blood pressure decrease than propofol but provided less hemodynamic stability than etomidate. Other agents, such as remimazolam and dexmedetomidine, often demonstrated superior hemodynamic profiles. Although midazolam can reduce stress responses and early blood pressure fluctuations, most studies did not evaluate BPV using comprehensive statistical methods. BPV and IOH were consistently associated with higher postoperative risks, particularly AKI in hypertensive patients.Conclusion: Intraoperative midazolam infusion may help maintain hemodynamic stability, but evidence regarding its effectiveness in reducing BPV and preventing IOH remains limited. Further randomized controlled trials are needed to directly assess the impact of midazolam infusion on BPV in hypertensive patients and compare it with other sedative agents.

Discussion

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Cite This Study

Ramadhani et al. (2025) conducted a review in Hypertension (n=10). Intraoperative midazolam infusion vs. Other sedative agents (propofol, etomidate, remimazolam, dexmedetomidine) or placebo was evaluated on Hemodynamic stability, blood pressure variability, and intraoperative hypertension. Intraoperative midazolam infusion caused a milder blood pressure decrease than propofol but provided less hemodynamic stability than etomidate, remimazolam, and dexmedetomidine.

synapsesocial.com/papers/6ac2fd227180a622ddd4dff3 https://doi.org/10.71282/jurmie.v2i12.1487

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Efek Infus Midazolam Intraoperatif Pada Variabilitas Tekanan Darah Dan Kejadian Hipertensi Intraoperatif Pada Pasien Hipertensi

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Efek Infus Midazolam Intraoperatif Pada Variabilitas Tekanan Darah Dan Kejadian Hipertensi Intraoperatif Pada Pasien Hipertensi

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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