Midazolam

Question 1

What is midazolam?

Answer 1

Midazolam (5 mg/1mL) is a short acting benzodiazepine and is a CNS depressant that induces amnesia, anaesthesia, hypnosis and sedation by enhancing the action of the inhibitory neurotransmitter GABA.

Metabolised by the liver & excreted by the kidneys.

Onset: 5-15 min IM, 1-3 min IV
Duration: variable
Half-life: 2.5hrs

Question 2

Indications for midazolam?

Answer 2

1. Generalised seizures/focal seizure (GCS 12 or above)
2. (CCP) Sedation for:
   - maintenance of an established LMA/ETT
   - procedures (e.g. TCP or cardioversion)
   - CPR induced consciousness
   - facilitating safe assessment & treatment of an agitated, head injured patient
   - an adjunct to opiate analgesia (fracture splinting/extrication/burns)
   - ketamine emergence
3. Acute behavioural disturbances (with a SAT score >2) unresponsive to droperidol (max dose) administration

Question 3

Contraindications for midazolam?

Answer 3

1. Allergy/ADR

Question 4

Precautions for midazolam?

Answer 4

1. Reduced dosages must be considered in:
   - low body weight, older or frail patients
   - patients with chronic renal failure, congestive cardiac failure or shock
2. Can cause severe respiratory depression in patients with COPD
3. Myasthenia gravis
   (a chronic autoimmune, neuromuscular disease that causes weakness in the skeletal muscles that worsens after periods of activity and improves after periods of rest)
4. Multiple sclerosis

Question 5

Side effects of midazolam?

Answer 5

1. Hypotension

2. Respiratory depression, particularly when associated with other CNS depressants including alcohol & narcotics

Question 6

What is the dose of midazolam for an adult with generalise/focal seizure or ABD?

Answer 6

Generalise/focal seizure:
5 mg NAS/IM
Repeated every 10 min
Total max dose 20 mg

5mg IV
Repeated every 5 min
Total max dose 20 mg

ABD: QAS clinical consult required in all circumstances

Question 7

What is the dose of midazolam for a paediatric with generalise/focal seizure or ABD?

Answer 7

Generalise/focal seizure:
200 microg/kg NAS/IM
Single dose cannot exceed 5 mg 
Repeated at 10 min intervals 
Total max dose 10 mg 

IV - CCP only

ABD: QAS clinical consult required in all circumstances