Midazolam

Question 1

Midazolam: Introduction

Answer 1

A water-soluable benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. This is due to its bonding with receptors in the CNS; its action is to increase the inhibitory effects of the GABA neurotransmitter on the GABA receptors and subsequent membrane threshold.

Midazolam is lipid-soluble in physiological PH and it reaches the CNS quickly

Use of a sedative agent should not be considered routine. Adopt a high threshold to offer or administer.

Question 2

Midazolam: Indication

Answer 2

Prolonged seizure activity - generalise seizure lasting >/= 5 minutes OR recurrent/status seizure activity as per CPG

Focal seizure activity which is prolonged (>/= 5 minutes) and is associated with a GCS </= 12 as per CPG

Second-line IV agent for maintenance of sedation after Droperidol for DAB

Question 3

Midazolam: Contraindication

Answer 3

Hypersensitivity

Use of midazolam for sedation after Ketamine requires ASMA consult

Question 4

Midazolam: Considerations

Answer 4

RAHM

Respiratory depression

Hypotension

Anterograde and retrograde amnesia

Myasthenia Gravis

Question 5

Midazolam: Precautions

Answer 5

Monitoring as soon as practicable
ETCO2 and SpO2 must be applied
In toxic levels can produce agitation
Paed: IM in 1mL, consult ASMA for repeat dose