| Name: |
MIDAZOLAM (VersedR) |
| Classification: |
Anxiolytic agent; sedative; anticonvulsant
- used in the initial control of seizures or in the treatment of status epilepticus
- has no long-term anticonvulsant activity
- useful in the management of alcohol withdrawal and delirium tremens
- muscle relaxant - useful in patient with tetanus
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| Dose: |
Loading Dose:
-
<55 y.o. 2 - 2.5 mg IV direct
-
>55 y.o. 1 - 1.5 mg IV direct
-
Reduce the dose by 30% in patients premedicated with narcotics and CNS depressants
Maintenance Infusion (Sedation):
- Initiate at 1 - 5 mg/hr; titrate to individual response and to target VAMAAS (tolerance may occur)
- Dosage reductions recommended in patients with CHF, septic shock, renal and/or hepatic dysfunction, low serum albumin, pulmonary insufficiency, COPD, or elderly patients
- Reassess dose Q12 H and wean to lowest dose required to achieve sedation target
|
| Administration: |
IV Infusion:
100 mg/50 mL dextrose 5% or sodium chloride 0.9% for syringe pump infusion |
| Contraindications: |
- Respiratory depression and partial airway obstruction, especially when combined with narcotics or in patients with hypercarbic respiratory disease
|
| Adverse Effects: |
- Respiratory depression and partial airway obstruction, especially when combined with narcotics
- Hypertension or hypotension
- Headache, drowsiness, dizziness, excessive sedation
- Thrombophlebitis
- Amnesia, lack of recall
- Withdrawal; prolonged use of continuous benzodiazepines should be weaned
|
| Antidote: |
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| Drug Interactions: |
- opioids/inhalation anaesthetics + midazolam = increased or prolonged sedation
|
| Monitoring Therapy: |
- Respiratory rate
- Oxygen Saturation
- Blood pressure
- Response to sedation
- Delirium screening
|
| Adult Critical Care Protocol: |
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
- May be titrated by a nurse in Adult Critical Care.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Order written to provide sedation during mechanical ventilation should be discontinued when patient is no longer receiving mechanical ventilation support.
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