Midazolam (Versed)

Category:

  • General anesthetic

Description:

  • Benzodiazepine sedative

Indications:

  • Preoperative sedation (IM)

  • General anesthesia induction, sedation for diagnostic endoscopic procedures, intubation (IV)

Contraindications:

  • Shock, coma, alcohol intoxication

  • Acute narrow-angle glaucoma

Precautions:

  • Pregnancy category D

  • COPD, CHF, chronic renal failure, hepatic disease, elderly

  • Debilitated, myasthenia gravis, other muscular dystrophies and myotonias

Adverse Reactions (Side Effects):

  • CNS: anxiety, confusion, euphoria, headache, insomnia, paresthesia, retrograde amnesia, slurred speech, tremors, weakness

  • CV: bigeminy, hypotension, nodal rhythm, PVCs, tachycardia

  • EENT: blocked ears, blurred vision, diplopia, loss of balance, nystagmus

  • GI: hiccups, increased salivation, nausea, vomiting

  • RESP: apnea, bronchospasm, coughing, dyspnea, laryngospasm, respiratory depression

  • SKIN: pain, pruritis, rash, swelling at injection site, urticaria

Dosage:

Administered intravenously, intramuscularly

  • Adult:            

    • Preoperative sedation: 

      • IM 70-80 mcg/kg 30-60 minutes before general anesthesia

    • Conscious sedation: 

      • IV using 1 mg/ml dilution, titrate slowly to desired effect; give no more than 2.5mg over at least 2 minutes; wait at least 2 minutes to fully evaluate effect; administer small doses to appropriate level of sedation as needed

    • Induction of general anesthesia: 

      • IV 150-350 mcg/kg over 30 seconds, wait 2 minutes follow with 25% of initial dose if needed; use lower doses for patients who are > 55 years age, premedicated, debilitated, or severe systemic disease

  • Child:            

    • Preoperative sedation: 

      • IM 80-200 mcg/kg

    • General anesthesia: 

      • IV 50-200 mcg/kg

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