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ASDC Journal of Dentistry For Children 1994Midazolam is a new short-acting benzodiazepine which is more potent than diazepam. Reports on its use in young pediatric dental patients is lacking in the literature.... (Clinical Trial)
Clinical Trial Randomized Controlled Trial Review
Midazolam is a new short-acting benzodiazepine which is more potent than diazepam. Reports on its use in young pediatric dental patients is lacking in the literature. The purpose of this study was to evaluate the sedative qualities of midazolam via the oral and nasal routes in 100 recalcitrant pediatric dental patients between 1.5 and 6 years of age. One half of the patients received oral midazolam at a dose of 0.5 mg/kg administered with 25 mg hydroxyzine pamoate suspension as a vehicle. The other half received nasal midazolam at a dose of 0.2 mg/kg. Nitrous oxide-oxygen inhalation and local anesthesia were used in all cases. The results indicated that a satisfactory level of sedation was achieved in approximately two thirds of the cases. Complications were rare, and not of clinical significance. There was no significant difference in the frequency of success or complications reported between the oral and nasal routes. The results of the present study support the need for future investigations to determine optimal pediatric dosages and regimens for each route.
Topics: Administration, Intranasal; Administration, Oral; Anesthesia, Dental; Child; Child Behavior; Child, Preschool; Conscious Sedation; Dental Anxiety; Female; Flumazenil; Humans; Hydroxyzine; Infant; Male; Midazolam
PubMed: 8089345
DOI: No ID Found -
Clinical Pharmacology in Drug... Jan 2022Letermovir is a human cytomegalovirus (CMV) terminase inhibitor for the prophylaxis of CMV infection and disease in allogeneic hematopoietic stem-cell transplant...
Letermovir is a human cytomegalovirus (CMV) terminase inhibitor for the prophylaxis of CMV infection and disease in allogeneic hematopoietic stem-cell transplant recipients. In vitro studies have identified letermovir as a potential cytochrome P450 (CYP) 3A inhibitor. Thus, the effect of letermovir on the CYP3A isoenzyme-specific probe drug midazolam was investigated in a phase 1 trial. Healthy female subjects received single-dose intravenous (IV; 1 mg) and oral (2 mg) midazolam on days -4 and -2, respectively. Letermovir 240 mg once daily was administered on days 1 to 6, and further single doses of midazolam 1 mg IV and oral midazolam 2 mg were administered on days 4 and 6, respectively. Pharmacokinetics, tolerability, and safety were monitored throughout the trial. Following coadministration with letermovir, the least square means ratio for maximum plasma concentration and area under the plasma concentration-time curve from time 0 to the last measurable concentration was 172.4% and 225.3%, respectively, for oral midazolam, and 105.2% and 146.6%, respectively, for midazolam IV. The area under the plasma concentration-time curve from time 0 to the last measurable concentration ratio of midazolam to 1-hydroxymidazolam increased slightly in the presence of letermovir following IV (8.8-13.1; 49% increase) and oral (3.3-5.3; 59% increase) midazolam. Letermovir reached steady state, on average, by days 5 to 6. All treatments were generally well tolerated. Letermovir demonstrated moderate CYP3A inhibition.
Topics: Acetates; Area Under Curve; Drug Interactions; Female; Healthy Volunteers; Humans; Midazolam; Quinazolines
PubMed: 34714967
DOI: 10.1002/cpdd.1027 -
Anaesthesiologie Und Reanimation 1989Midazolam is a short-acting benzodiazepine with anxiolytic, sedative-hypnotic and marked amnestic properties. Due to an excellent local tolerability, its slight... (Review)
Review
Midazolam is a short-acting benzodiazepine with anxiolytic, sedative-hypnotic and marked amnestic properties. Due to an excellent local tolerability, its slight reduction in blood pressure and minor dose-related respiratory depression, midazolam is useful for anaesthetic induction and postoperative (long-term) sedation especially for intensive care patients. Compared to other benzodiazepines, midazolam exhibits a rapid onset of action and a fast hepatic elimination (t1/2 2 to 4h; CL 400 to 600 ml/min). In patients with liver cirrhosis and critically ill patients, an impaired elimination and longer duration of action has to be taken into consideration. Likewise, in the elderly an amplified response will be noted, because of the increased sensitivity of the central nervous system to benzodiazepines during aging. In such populations at risk, "normal" dosage of midazolam has to be reduced at least by factor 2.
Topics: Chemical Phenomena; Chemistry; Humans; Midazolam
PubMed: 2690843
DOI: No ID Found -
BMC Palliative Care Jun 2020French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The...
BACKGROUND
French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes.
METHODS
Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished.
RESULTS
A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival.
CONCLUSIONS
After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.
Topics: Adult; Aged; Aged, 80 and over; Female; France; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Neoplasms; Palliative Care; Retrospective Studies
PubMed: 32560644
DOI: 10.1186/s12904-020-00592-3 -
Clinical Therapeutics 1997Critically ill patients often benefit from sedation to optimize their care and their ventilatory support. Ideally, incremental doses of a drug are administered to... (Review)
Review
Critically ill patients often benefit from sedation to optimize their care and their ventilatory support. Ideally, incremental doses of a drug are administered to produce the desired level of sedation without toxicity or overdose. Because metabolism and elimination of drugs are often altered in critically ill patients, knowledge of the pharmacokinetics of sedative hypnotics is essential to ensure their appropriate selection and administration. Furthermore, the administration of sedatives via continuous infusion minimizes fluctuations in drug concentrations and permits more consistent control of the patient's agitation and anxiety. Physician preference and the patient's individual requirements and underlying diseases are the primary determinants for the selection of a given sedative. Benzodiazepines are the most commonly used sedatives in critical care. Midazolam is readily distinguished from other benzodiazepines because of its rapid onset and short duration of action, low incidence of thrombophlebitis and pain on injection, and minimal cardiovascular and respiratory effects. The physiochemical properties of midazolam allow for enhanced water solubility, which limits physicochemical incompatibilities. These properties make midazolam a valuable sedative that can be given via continuous intravenous infusion in the intensive care unit.
Topics: Animals; Humans; Hypnotics and Sedatives; Infusions, Intravenous; Intensive Care Units; Midazolam
PubMed: 9220206
DOI: 10.1016/s0149-2918(97)80126-9 -
Anesthesia and Analgesia Jun 2004
Topics: Bioethical Issues; Humans; Injections, Spinal; Midazolam
PubMed: 15155297
DOI: 10.1213/01.ANE.0000127033.05715.6E -
Journal of Child Neurology Dec 1998Status epilepticus is more common among children than young adults. Children might be less likely to die and might be resistant to permanent neurologic damage due to... (Review)
Review
Status epilepticus is more common among children than young adults. Children might be less likely to die and might be resistant to permanent neurologic damage due to status epilepticus, but significant sequelae also have been demonstrated. Aggressive intervention and rapid termination of seizures contribute significantly to better prognosis and reduced mortality from status epilepticus. Initial treatment of status epilepticus typically consists of either diazepam or lorazepam, immediately followed by phenytoin or phenobarbital. However, approximately 100% to 15% of status epilepticus episodes are refractory to these conventional therapies. Traditionally, refractory status epilepticus is treated with barbiturate coma or general anesthetics, both of which require invasive cardiorespiratory and hemodynamic monitoring and are associated with significant complications. Midazolam is a water-soluble benzodiazepine with a fast onset of action, a short half-life, and inactive metabolites that has been very effective in terminating seizures refractory to diazepam, lorazepam, phenytoin, and phenobarbital in pediatric patients. Midazolam is a valuable treatment option for refractory status epilepticus, especially in pediatric patients.
Topics: Anti-Anxiety Agents; Child; Drug Resistance; Humans; Midazolam; Recurrence; Status Epilepticus; Treatment Outcome
PubMed: 9881528
DOI: 10.1177/088307389801301201 -
Anesthesiology Jan 2008
Topics: Age Factors; Animals; Brain; Humans; Midazolam
PubMed: 18156876
DOI: 10.1097/01.anes.0000296717.85521.b5 -
Medicine Nov 2020Anxiolytic premedication requires careful consideration owing to potential side effects including delayed recovery after ambulatory anesthesia. We aimed to compare the... (Comparative Study)
Comparative Study Randomized Controlled Trial
Differences in midazolam premedication effects on recovery after short-duration ambulatory anesthesia with propofol or sevoflurane for gynecologic surgery in young patients: A randomized controlled trial.
BACKGROUND
Anxiolytic premedication requires careful consideration owing to potential side effects including delayed recovery after ambulatory anesthesia. We aimed to compare the effect of midazolam on recovery profiles postoperatively, depending on whether propofol or sevoflurane was the primary anesthetic.
METHODS
We enrolled 226 patients (age, 18-50 years) undergoing ambulatory gynecologic laparoscopic surgery. Patients were categorized into propofol without midazolam (P), propofol with midazolam (MP), sevoflurane without midazolam (S), and sevoflurane with midazolam (MS) groups. As premedication, placebo or 0.02 mg/kg intravenous midazolam was used. The primary outcome was the difference in the time from anesthetic discontinuation to eye opening in response to verbal command. Secondary outcomes included postoperative nausea and pain occurrence and time to reach the discharge score.
RESULTS
The time from anesthetic discontinuation to eye opening was longer in the MP group (n = 49) than in the P group (n = 50; P < .001) but was not significantly different between the MS (n = 50) and S groups (n = 49; P = .1). Midazolam premedication did not significantly affect postoperative nausea in the MP group compared with that in the P group (P = .3) but had a nausea prevention effect in the MS group compared with that in the S group (P < .001). The time to reach the discharge score was similar in all patients regardless of midazolam administration.
CONCLUSION
In the recovery from short-duration ambulatory gynecologic surgery in young patients, intravenous midazolam premedication showed positive effects on postoperative nausea without affecting the time from anesthetic discontinuation to eye opening with sevoflurane-based anesthesia but prolonged the time from anesthetic discontinuation to eye opening with propofol-based anesthesia. Because this difference between the propofol groups is not clinically significant, the results support midazolam premedication in young women. Further studies assessing larger populations are needed.
Topics: Adult; Ambulatory Surgical Procedures; Anesthesia Recovery Period; Anesthetics, Inhalation; Anesthetics, Intravenous; Anti-Anxiety Agents; Arousal; Female; Gynecologic Surgical Procedures; Humans; Midazolam; Middle Aged; Pain, Postoperative; Patient Discharge; Postoperative Nausea and Vomiting; Propofol; Prospective Studies; Recovery of Function; Sevoflurane; Time Factors
PubMed: 33217829
DOI: 10.1097/MD.0000000000023194 -
Pediatric Neurology Aug 2020We compared the efficacy and safety of intramuscular with buccal midazolam as first-line treatment for active seizures in children brought to the emergency department. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
We compared the efficacy and safety of intramuscular with buccal midazolam as first-line treatment for active seizures in children brought to the emergency department.
METHODS
In a double-blind, double-dummy randomized trial, patients with an active seizure lasting more than five minutes received blinded treatments on arrival. We employed deferred consent. The proportion of patients with cessation of seizure within five minutes of drug administration was the primary efficacy outcome; proportions needing additional medication to control seizure, duration of seizure activity, and side effects were secondary outcomes.
RESULTS
We enrolled 150 children presenting with active seizure, age range 4.5 to 167.5 months. Cessation of seizure occurred in 61% of the intramuscular and 46% of the buccal treatment groups, (P = 0.07, difference 15.5%, 95% confidence interval for the difference -1.0 to 32.0%). Proportions requiring additional anti-seizure treatment were 39% in the intramuscular and 51% in the buccal groups. Mean duration of seizure activity after administration of study medication was 15.9 minutes (S.D. 28.7) in the intramuscular and 17.8 minutes (S.D. 27.5) in the buccal group. One patient in the intramuscular group developed respiratory depression and hypotension; there were no side effects attributed to investigational treatment in the buccal group.
CONCLUSIONS
Efficacy and safety of intramuscular midazolam as first-line treatment for pediatric seizures compare favorably to that of buccal midazolam.
Topics: Administration, Buccal; Adolescent; Anticonvulsants; Child; Child, Preschool; Double-Blind Method; Emergency Service, Hospital; Female; Humans; Infant; Injections, Intramuscular; Male; Midazolam; Outcome Assessment, Health Care; Seizures
PubMed: 32387007
DOI: 10.1016/j.pediatrneurol.2020.03.011