A benzodiazepine - It is used to cause relaxation or sleep before surgery and to block the memory of... more
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Use only when adequate treatment facilities for appropriate management of therapy and complications are available.
For deeply sedated pediatric patients, an individual other than the clinician performing the procedure should be dedicated to monitoring the patient throughout the procedure.
Respiratory Effects
Associated with respiratory depression and respiratory arrest, especially when used for sedation in non-critical-care settings. (See Respiratory and Cardiovascular Effects under Cautions.)
Death or hypoxic encephalopathy has resulted when respiratory depression was not recognized promptly and treated effectively.
Dosage and Administration Considerations for Procedural Sedation
Initial IV dose for healthy adults should not exceed 2.5 mg. (See Dosage under Dosage and Administration.)
Lower dosages are necessary in patients >60 years of age, debilitated patients, and patients receiving concomitant opiates or other CNS depressants. (See Dosage and also Special Populations, under Dosage and Administration.)
Titrate initial and subsequent dosages slowly; administer the appropriate dose over ≥2 minutes and wait an additional 2 or more minutes to fully evaluate the sedative effect.
Administer by direct IV injection as the 1-mg/mL solution or dilute the 1- or 5-mg/mL solution to facilitate slower administration.
Pediatric Dosage and Administration Considerations
Calculate pediatric dosage on a mg/kg basis. Initial dose is dependent on age, procedure, and route; titrate subsequent dosages slowly. (See Dosage: Pediatric Patients, under Dosage and Administration.)
Do not administer by rapid IV injection in neonates. Severe hypotension and seizures have been reported following rapid IV administration, particularly with concomitant administration of fentanyl.
Preoperative Sedation, Anxiolysis, and Anterograde Amnesia
Preoperatively, to produce sedation, relieve anxiety, and provide anterograde amnesia.
Some clinicians consider midazolam the benzodiazepine of choice for preoperative use for short surgical procedures because of its relatively rapid onset and short duration of effect and improved local tolerance at the site of injection compared with other currently available parenteral benzodiazepines.
Some clinicians consider midazolam the benzodiazepine of choice for moderate sedation (formerly known as conscious sedation) prior to short procedures because of its relatively rapid onset and short duration of action, pronounced amnesic effect, and improved local tolerance at the site of injection compared with other currently available IV benzodiazepines.
Induction and Maintenance of Anesthesia
Induction of general anesthesia prior to administration of other anesthetic agents. Induction with midazolam provides anxiolysis, anterograde amnesia, and dose-related hypnotic effects (progressing from sedation to loss of consciousness), but not analgesia.
An acceptable alternative to thiopental for induction of anesthesia; midazolam’s slow onset and long duration of action and variability in response relative to those of thiopental preclude it from becoming the drug of choice for induction of anesthesia in most patients, particularly outpatients and patients undergoing short surgical procedures.
Maintenance of anesthesia during short surgical procedures, usually in conjunction with inhalation anesthetic agents, balanced anesthesia (e.g., nitrous oxide and oxygen), and/or opiate agonists (e.g., fentanyl). Should not be used alone for maintenance of anesthesia.
Use for maintenance of anesthesia during relatively long surgical procedures has not been fully evaluated to date.
A preferred drug for sedation of acutely agitated patients in critical-care settings because of its rapid onset and short duration of action.
As effective as propofol and appears to have a better adverse effect profile (e.g., less hypotension) than propofol; however, midazolam appears to have a more variable effect on recovery of consciousness and time to recovery of function after cessation of therapy than propofol.
Recommended for short-term (≤24 hours) sedation only, since the effects of the drug on awakening and the time to extubation are unpredictable when midazolam infusions are administered over longer periods (e.g., exceeding 48–72 hours).
Insomnia
Has been used for short-term management of insomnia†.
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