Midazolm

dr.joan

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