The use of midazolam and opioid associations in anesthesia (ataranalgesia).

Ataranalgesia (ATA) is realized by the association of a strong morphinomimetic, a benzodiazepine (BZD) and a curare. It is an anesthesia technique derived from neuroleptanalgesia, one of the most employed modern anesthesia techniques. In this formula, midazolam, a hydrosoluble BZD, with a rapid onset of action and a shorter duration of action than the other substances of this group (diazepam or flunitrazepam) was rapidly introduced. For the induction of an ATA, we mix in the same syringe the loading doses of the BZD, the opiate (fentanyl, alfentanil or sulfentanil) and the curare (pancuronium or atracurium) and we administer them simultaneously. The maintenance of anesthesia is performed by perfusion of the opioid with a constant flow, deliberately underdosed, in addition to microboli of the 3 chosen substances as needed to assure the stability of anesthesia. In this anesthesia mixture, midazolam ensures sedation, sleep, amnesia and reinforces and stabilizes the analgesic or myorelaxant action of the two other substances. To realize this technique with success, it is useful to remember the pharmacological interactions that are created between midazolam, the morphinomimetics and the curare. This report will focus on their description. The possibilities to use midazolam in anesthesia and the controllability of ATA have been enlarged since the synthesis of the antidote Ro 15-1788 (Anexate).