Midazolam, a short-acting
benzodiazepine used for preoperative anxiolysis, may also have pharmacologic properties that could further reduce the incidence of
postoperative nausea and vomiting (
PONV) in high-risk patients when included in a multimodal
antiemetic protocol. However, concerns remain that the sedating properties of
midazolam will delay discharge after short outpatient procedures. A retrospective data analysis (N = 4,057) investigated effects of
midazolam on postoperative
antiemetic administration and
length of stay following
cancer-related outpatient procedures over 15 months. Following initial univariate analysis, a multivariable model adjusting for Apfel score, surgical service, age, length of surgery, and type of
anesthesia was created to test these associations. The multivariable analysis demonstrated that
midazolam was associated with reduced need for postoperative
antiemetic medications (3.2% lower than no-
midazolam group; 95% confidence interval = 0.03%-6.0%, P = .032). Furthermore, the multivariable analysis demonstrated no clinically significant effect on postoperative
length of stay (7.9 minutes shorter in
midazolam group; 95% confidence interval = -20 to 4.4,
P = .2). In patients for whom
midazolam is not otherwise indicated, evidence is insufficient to warrant
midazolam administration solely to prevent
PONV. Randomized trials are needed to provide an accurate estimation of the effect size of
midazolam for
PONV in these patients.