Midazolam

Question 1

Pharmacology and presentation of Midazolam?

Answer 1

5mg/1ml or 15mg/3ml Ampoule

Midazolam is a short-acting CNS depressant with anxiolytic, amnesia, anaesthesia, sedative, anticonvulsant and hypnotic effects. It achieves this by enhancing the action of the inhibitory neurotransmitter gamma-amino butyric acid (GABA). Depressant effects occur at all levels of the CNS, including respiratory drive.

Question 2

Indicators of Midazolam?

-ICES

Answer 2

• Seizures with GCS<12
• Extreme agitation (SAT Score 2+ - 3+ post Ketamine)
• Sedation for cardioversion or transthoracic pacing
• Sedation for intubation (post-intubation, SFI and RSI).

Question 3

Contraindications of Midazolam?

Answer 3

• Known allergy.

Question 4

Cautions of Midazolam?
- 2xdepress and reduce

Answer 4

• Consider reduced doses for elderly/frail, patients with chronic renal failure, congestive cardiac failure or shock
• CNS depression effects of benzodiazepines are potentiated in the presence of narcotics and tranquillisers, including alcohol
• Can cause severe respiratory depression, particularly in patients with COPD
• Myasthenia Gravis
• Multiple Sclerosis.

Question 5

Side Effects of Midazolam?
- HARD

Answer 5

• Decreased level of consciousness
• Loss of airway control
• Respiratory depression
• Hypotension.

Question 6

Dosing Regimes of Midazolam?

Answer 6

Seizures IM
- Adult >60kg = 10mg IM, repeating 5-10mg IM 10 minutely to a max total dose of 30mg (both IM/IV)
- Adult <60kg or frail = 5mg IM, repeating 5-10mg IM 10 minutely to a max total dose of 30mg (both IM/IV)
- Small infant (<3mths) = 0.5mg IM, repeating initial dose at 10mins once
- Large infant (up to 12mths) = 1mg IM, repeating initial dose at 10mins once
- Small Child 1-4yrs = 2.5mg IM, repeating initial dose at 10mins once
- Large child 4-11yrs = 2.5-5mg IM, repeating initial dose at 10mins once

Seizures IV/IO
- Adult >60kg = 5mg IV/IO, repeating 2.5-5mg IV/IO 5 minutely, to a max total dose of 30mg (both IM/IV)
- Adult <60kg or frail = 2.5mg IV/IO, repeating 2.5-5mg IV/IO 5 minutely, to a max total dose of 30mg (both IM/IV)

Question 7

Onset and duration of Midazolam?

Answer 7

• Onset = 30 seconds IV or 5–10 minutes IM
• Duration = 5–10 minutes