Safety of Oral Midazolam as a Perioperative Anxiolytic for Outpatient Dermatologic Procedures

Dermatol Surg. 2020 Dec;46(12):1588-1592. doi: 10.1097/DSS.0000000000002624.


Background: Perioperative anxiety can negatively impact patient satisfaction and can complicate outpatient dermatologic procedures.

Objective: Evaluate adverse events associated with oral midazolam as a perioperative anxiolytic during dermatologic surgery and assess whether an enhanced monitoring approach is associated with an increased detection rate.

Materials and methods: Five hundred cases (250 before and after change in monitoring) where patients were administered oral midazolam between July 2015 and May 2017 were retrospectively reviewed. The number of procedures, type of procedures, dose in milligrams, number of doses, major and minor adverse events, and vital signs were recorded.

Results: The difference in number of treatment sites, types of procedures, and total dose administered was not significant. There were minor but significant differences in the mean change in blood pressure, heart rate, respiratory rate, and Richmond Agitation and Sedation Scale score before and after the procedure but not oxygen saturation. These vital sign changes were not clinically significant. There were zero major adverse events in both groups. There were 2 patients who became transiently hypoxic.

Conclusion: Oral midazolam administration was not associated with major adverse events including in the more intensively monitored group. This supports its use as an anxiolytic for outpatient dermatologic procedures.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Surgical Procedures / adverse effects*
  • Ambulatory Surgical Procedures / psychology
  • Anti-Anxiety Agents / administration & dosage
  • Anti-Anxiety Agents / adverse effects*
  • Anxiety / etiology
  • Anxiety / prevention & control*
  • Anxiety / psychology
  • Dermatologic Surgical Procedures / adverse effects*
  • Dermatologic Surgical Procedures / psychology
  • Dose-Response Relationship, Drug
  • Drug Monitoring / statistics & numerical data
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / etiology
  • Female
  • Humans
  • Male
  • Midazolam / administration & dosage
  • Midazolam / adverse effects*
  • Middle Aged
  • Patient Satisfaction
  • Perioperative Care / adverse effects
  • Perioperative Care / methods
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Anti-Anxiety Agents
  • Midazolam