Effects of Midazolam on Postoperative Nausea and Vomiting and Discharge Times in Outpatients Undergoing Cancer-Related Surgery.

This was a single-center retrospective chart review, not a randomized trial, so it cannot prove midazolam caused the differences. Rescue antiemetic use was used as a stand-in for postoperative nausea and vomiting, so actual nausea and vomiting may have been more common. Patients also received dexamethasone, ondansetron, aprepitant when indicated, clinician-judged antiemetics for monitored anesthesia care, intraoperative opioids, and recovery unit rescue antiemetics, so the contribution of midazolam alone cannot be separated. Unadjusted results were opposite to adjusted results because surgical services, midazolam use, and surgery length differed. The sample had more female patients and did not include all types of outpatient cancer surgery, so results may not apply to men or other surgeries. Chemotherapy at the time of surgery was not available as a covariate, although the authors thought it was rare. The study covered 15 months, which may not address all possible variables.

Do not conclude that midazolam alone prevents PONV or delays discharge. This was a retrospective chart review, patients also received dexamethasone, ondansetron, aprepitant when indicated, clinician-judged antiemetics for monitored anesthesia care, intraoperative opioids, and recovery unit rescue antiemetics, and the authors said evidence is insufficient to warrant midazolam solely for PONV.