Midazolam

Question 1

Midazolam Intro

Answer 1

• A water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (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 never be considered routine. Have a high threshold to offer or administer.

Question 2

Midazolam Indications

Answer 2

• Prolonged seizure activity - generalised 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 administration for Disturbed and/or abnormal behaviour

Question 3

Midazolam Contraindications

Answer 3

• Hypersensitivity
• Use of Midazolam for sedation after Ketamine requires ASMA authority

Question 4

Midazolam Precautions / Notes

Answer 4

• Early monitoring as soon as practicable is required when administering midazolam; including SpO2, respiratory rate, pulse and blood pressure
• SpO2 and EtCO2 monitoring must be applied whenever level of consciousness drops ~RASS -2 or below
• Psychostimulants, in toxic levels can produce severe agitation and psychotic behaviour
• Paediatric patients:
  – Intramuscular administrations should always be prepared in a 1mL IM syringe
  – Have a low threshold to consult with ASMA when repeat or maintenance doses are required for sedation

Question 5

4 Midazolam Special Considerations (Side Effects)

Answer 5

Respiratory depression
Hypotension
Anterograde and retrograde amnesia
Myasthenia Gravis

Question 6

Midazolam Presentation

Answer 6

15mg in 3mls