Midazolam

Question 1

Clinical condition or situation to which this PGD applies

Answer 1

Procedural sedation to facilitate painful procedures and facilitate patient extrication, transport and ongoing management.

Question 2

Inclusion criteria

Answer 2

Procedural sedation to facilitate patient safety, extrication, transport and ongoing management

Procedural sedation for facilitation or painful procedures for example external pacing

Co-administration with Ketamine to reduce and or treat emergence phenomenon

Ongoing sedation of a patient who is being ventilated via a correctly positioned ET tube or working LMA - TCC required in all cases

Question 3

Exclusion criteria

Answer 3

Paediatrics <6 months

Hypersensitivity to Midazolam

Severe respiratory depression

Trapped casualties where access to the airway is not possible

Question 4

Cautions

Answer 4

Patients with severe cardiac or respiratory disease

History of drug and alcohol abuse / acutely intoxicated

Hypovolaemia, hypotension, hypoxia or hypoventilation

Severe renal impairment

Multiple co-morbidities

Question 5

Dose and frequency

Answer 5

SEDATION

Stable adult:
- 1-2mg, titrated to maximum 7.5mg

Unstable / 60+ adult:
- 0.5mg - 1mg, titrated to maximum 3.5mg

Paediatric (6 months - 5 years)
- 50mcg/kg up to max 2mg.

Paediatric 6 years - 12 years
- 25mcg - 50mcg to max 3mg.

SEIZURES

IV/IO - 2mg initial dose followed by repeated 2mg every 2 minutes. Max 10mg.

Paediatric buccal
- Up to 6 months - 300mcg/kg max 2.5mg
- 6 months - 1 year 2.5mg max
- 1-5 - 5mg max
- 5-10 - 7.5mg max
- over 10 - max 10mg.

Can be repeated once after 10 minutes if required

Question 6

Presentation

Answer 6

5mg in 5ml syringe predrawn

1mg / ml