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The Journal of Emergency Medicine 1997Midazolam is a familiar agent commonly used in the emergency department to provide sedation prior to procedures such as laceration repair and reduction of dislocations.... (Review)
Review
Midazolam is a familiar agent commonly used in the emergency department to provide sedation prior to procedures such as laceration repair and reduction of dislocations. Midazolam is also effective in the treatment of generalized seizures, status epilepticus, and behavioral emergencies, particularly when intravenous access is not available. Midazolam is often employed as an induction agent for rapid sequence endotracheal intubation. Midazolam has a rapid onset of action following intravenous, intramuscular, oral, nasal, and rectal administration. Only 50% of an orally administered dose reaches the systemic circulation due to extensive first-pass metabolism. Midazolam is metabolized by the cytochrome P450 enzyme system to several metabolites including an active metabolite, alpha-hydroxymidazolam. Cytochrome P450 inhibitors such as cimetidine can profoundly reduce the metabolism of midazolam. Midazolam has a half-life of approximately 1 h, but this half-life may be prolonged in patients with renal or hepatic dysfunction. Midazolam has been associated with respiratory depression and cardiac arrest when used in combination with an opioid, particularly in the elderly, although all ages are at risk for respiratory depression. Midazolam is relatively free of side effects when used alone and offers several advantages over traditional pharmacological agents such as chloral hydrate and the combination of meperidine, chlorpromazine, and promethazine. Hiccups, cough, nausea, and vomiting are the most commonly reported adverse effects. Many of the adverse effects associated with midazolam can be reversed rapidly by the administration of flumazenil, a competitive benzodiazepine receptor antagonist. Midazolam is a safe and effective agent for providing sedation in the emergency department.
Topics: Conscious Sedation; Drug Interactions; Emergency Service, Hospital; Humans; Hypnotics and Sedatives; Metabolic Clearance Rate; Midazolam; Tissue Distribution
PubMed: 9258787
DOI: 10.1016/s0736-4679(97)00022-x -
Clinical Pharmacy Jul 1987The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, dosage, and cost and availability of midazolam hydrochloride are... (Review)
Review
The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, dosage, and cost and availability of midazolam hydrochloride are reviewed. The anxiolytic, sedative, hypnotic, anticonvulsant, muscle-relaxant, and amnesic properties of midazolam are similar to those of other injectable benzodiazepines. Midazolam is approximately two to four times as potent as diazepam. Midazolam hydrochloride is water soluble (resulting in fewer local adverse reactions after injection), has a rapid onset and short duration of action, and causes relatively mild cardiovascular and respiratory effects. The drug generally is well tolerated. Midazolam is a good premedicant for general or regional anesthesia. Its greatest use will probably be for conscious sedation during surgical or diagnostic procedures performed under local or regional anesthesia. Induction of anesthesia with midazolam alone is somewhat unpredictable; opiate pretreatment makes induction more consistent. Midazolam is a less reliable induction agent than thiopental, but because it produces fewer adverse cardiovascular and respiratory effects than thiopental, midazolam appears to be a safer induction agent for elderly patients or patients with cardiovascular disease. The recommended dose of midazolam for preoperative sedation is 0.07-0.1 mg/kg given by intramuscular injection one hour before surgery. For conscious sedation, 0.1-0.15 mg/kg intravenously in divided doses is usually adequate. Lower doses of midazolam are recommended for elderly or debilitated patients and patients who have severe liver disease. The costs of equipotent doses of midazolam and injectable diazepam are similar. An oral dosage form is under investigation in the United States. Midazolam's pharmacologic and pharmacokinetic profile makes it an attractive alternative to other injectable benzodiazepines used in anesthesia.
Topics: Amnesia; Anesthesia; Anxiety; Cardiovascular System; Humans; Midazolam; Premedication; Respiration
PubMed: 3319363
DOI: No ID Found -
European Journal of Heart Failure Oct 2022Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema (ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE.
METHODS AND RESULTS
A randomized, multicentre, open-label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in-hospital all-cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30-day mortality and SAE. Analyses were made on an intention-to-treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in-hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratio[RR] 0.71, 95% confidence interval [CI] 0.29-1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22-0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30-0.92; p = 0.03).
CONCLUSION
Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.
Topics: Humans; Adolescent; Midazolam; Morphine; Pulmonary Edema; Heart Failure; Hospital Mortality
PubMed: 35780488
DOI: 10.1002/ejhf.2602 -
Krankenpflege Journal 1996
Topics: Drug Interactions; Humans; Hypnotics and Sedatives; Midazolam; Patient Selection
PubMed: 8850856
DOI: No ID Found -
Zhongguo Dang Dai Er Ke Za Zhi =... Oct 2021To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.
METHODS
A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (=60) and an observation group (=58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 μg/mL) at 1 μg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 μg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T), at the time of inserting the bronchoscope (T), when the bronchoscope reached the glottis (T), when the bronchoscope reached the carina (T), and when the bronchoscope entered the bronchus (T). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded.
RESULTS
Compared with the control group, the observation group had significantly decreased MAP at T to T and HR at T to T (<0.05). Compared with that at T, MAP was significantly increased at T to T in the control group and at T in the observation group (<0.05). HR was significantly higher at T to T than at T0 (<0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia (<0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups (>0.05).
CONCLUSIONS
Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.
Topics: Bronchi; Bronchoscopy; Child; Dexmedetomidine; Humans; Hypnotics and Sedatives; Midazolam; Prospective Studies
PubMed: 34719411
DOI: 10.7499/j.issn.1008-8830.2107075 -
Journal of Zoo and Wildlife Medicine :... Mar 2019The intracoelomic implantation of satellite transmitters is associated with lower survival in surf scoters () compared with other species of diving ducks, potentially...
The intracoelomic implantation of satellite transmitters is associated with lower survival in surf scoters () compared with other species of diving ducks, potentially due to physiologic alterations following physical exertion and stress caused by handling and confinement. The effect of intranasal administration of midazolam hydrochloride on survival of surf scoters surgically implanted with intracelomic transmitters was evaluated. Shortly after their capture in Forestville (QC, Canada) in the fall of 2013, 26 randomly selected adult female surf scoters were administered midazolam hydrochloride (4.6-5.9 mg/kg) intranasally. The same volume of saline (1 mL) was given to another 26 adult female surf scoters as a control group. All birds were surgically implanted with an intracoelomic transmitter equipped with a percutaneous antenna. Transmitters were programmed to transmit 2 hr each day for 30 days after implantation, and mortality was estimated for each group using the telemetry data. The association between the administration of midazolam and survival was assessed while controlling for other factors such as body mass, transmitter-mass-to-body-mass ratio, hematocrit, total solids, and duration of surgery, anesthesia, and confinement. The odds of presumed death in the saline group were 5.3 times higher than in the midazolam group (95% confidence interval: 1.7, 19.0; = 0.004). The presumed mortality at 30 days for the midazolam group (23%) was lower than for the saline group (61%). No other variable was significantly associated with survival. These results suggest that sedation with midazolam shortly after capture increased the postsurgical survival of female surf scoters surgically implanted with intracoelomic transmitters.
Topics: Administration, Intranasal; Animals; Animals, Wild; Anti-Anxiety Agents; Ducks; Female; Hypnotics and Sedatives; Longevity; Midazolam; Prostheses and Implants; Surgical Procedures, Operative; Telemetry
PubMed: 31120675
DOI: 10.1638/2018-0115 -
European Review For Medical and... 2006Benzodiazepines have been involved during the years in the prevention and treatment of Post-Operative Nausea and Vomiting (PONV). Midazolam, a short acting... (Review)
Review
Benzodiazepines have been involved during the years in the prevention and treatment of Post-Operative Nausea and Vomiting (PONV). Midazolam, a short acting benzodiazepine widely used as a premedicant before surgery, for induction of anaesthesia, and for conscious sedation, has been particularly studied, sometimes with conflicting results. This paper will discuss the possible mechanisms of action of midazolam in PONV management and its fields of application (adults and children undergoing surgery, treatment of persistent postoperative emesis), as far as potentialities of other non-traditional anti-emetics, maybe ready to get out the arena of case reports, and the need of further studies on postoperative anti-emetics in their efficacy in treating established PONV.
Topics: Adult; Animals; Antiemetics; Child; Humans; Midazolam; Postoperative Nausea and Vomiting; Premedication; Randomized Controlled Trials as Topic
PubMed: 16875045
DOI: No ID Found -
Lancet (London, England) Aug 1988
Topics: Aged; Drug Combinations; Flumazenil; Gastroscopy; Humans; Midazolam
PubMed: 2899787
DOI: No ID Found -
Expert Review of Neurotherapeutics Jul 2014Midazolam is a short-acting benzodiazepine that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage... (Review)
Review
Midazolam is a short-acting benzodiazepine that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage of being water-soluble, with a rapid onset of action and it can be administered orally or intranasally, implementing an early intervention at the pre-hospital setting. This article aims to provide an overview of intranasal midazolam in the acute management of epileptic seizures. Available data suggest that midazolam 0.2 mg/kg is as effective as diazepam 0.5 mg/kg, especially in children with febrile or afebrile seizures. Local mucosal irritation seems to occur in less than one-third of cases while serious side effects such as respiratory depression in about 1%. Future studies need to be focused on adults and optimized technologies for intranasal delivery. Moreover, comparisons with buccal midazolam are warranted.
Topics: Administration, Intranasal; Anticonvulsants; Epilepsy; Humans; Midazolam
PubMed: 24910118
DOI: 10.1586/14737175.2014.925398 -
Lancet (London, England) Sep 1988
Topics: Animals; Humans; Midazolam
PubMed: 2901537
DOI: 10.1016/s0140-6736(88)90492-8