Midazolm
Trade names: Dormicum
Class: Anxiolytics,sedative and anticonvulsant
Pregnancy:
(Category D) Action:
Like other benzodiazepines, midazolam acts on
the benzodiazepine binding site of GABAA receptors. When bound it enhances the
binding of GABA to the GABAA receptor which results in inhibitory effects on
the central nervous system.[1]
Uses:
produce sleepiness or
drowsiness and to relieve anxiety before surgery or certain procedures. Dose:
conscious sedation,
by slow intravenous injection (approx. 2 mg/minute), initially 2–2.5 mg
(ELDERLY 0.5–1 mg), increased if necessary in steps of 1 mg (ELDERLY 0.5–1 mg);
usual range 3.5–7.5 mg, ELDERLY max. 3.5 mg; CHILD by intravenous injection over
2–3
minutes, 6 months–5 years
initially 50–100 micrograms/kg,
By intramuscular injection, 50–150
micrograms/kg; max. 10 mg
Premedication,
by deep intramuscular injection, 70–100 micrograms/kg (ELDERLY 25– 50
micrograms/kg) 20–60 minutes before induction, usual dose 2–3 mg; CHILD 1–15
years 80–200 micrograms/kg
Sedation of patients receiving intensive care,
by intravenous infusion 20-50
microgram /kg/hour
Contraindications: Most are
relative contraindications.
• Hypersensitivity,
• acute narrow angle glaucoma,
• shock, hypotension, head injury, and drug or alcohol use.
Side effects:
Residual 'hangover' effects after
nighttime administration of midazolam such as sleepiness, impaired psychomotor
and cognitive functions may persist into the next day which may impair the
ability of users to drive safely and increase risks of falls and hip fractures.
Nursing
considerations:
• Prior to the intravenous administration of midazolam in any
dose, the immediate availability of oxygen, resuscitative drugs, age- and
size-appropriate equipment for bag/valve/mask ventilation and intubation, and
skilled personnel for the maintenance of a patent airway and support of
ventilation should be ensured.
• Patients
should be continuously monitored with some means of detection for early signs
of hypoventilation, airway obstruction, or apnea, ie, pulse oximetry.
Hypoventilation, airway obstruction, and apnea can lead to hypoxia and/or
cardiac arrest unless effective countermeasures are taken immediately.
• The immediate availability of specific reversal agents
(flumazenil) is highly recommended. Vital signs should continue to be monitored
during the recovery period. Because intravenous midazolam depresses respiration
