Description and indication for use
Midazolam is a short-acting
benzodiazepine. It is able to induce
sedation, hypnosis, amnesia and anaesthesia, depending on the dose
administered, the route of administration and the presence of other
medication. It also has anti-convulsant
and muscle relaxant properties.
It is used as a short-acting sedative
agent.
Dose
For induction of anaesthesia (intubated babies only):
IV:
0.15 to 0.3 mg/kg/dose.
As a sedative/amnesic (intubated babies only):
IV Infusion:
0.5 to 2 microgram/kg/minute.
Non-intubated babies:
Discuss with consultant
(*Can be given intranasal 0.2 to 0.3
mg/kg/dose using 5 mg/mL injectable form - Check with consultant prior to
administration).
If analgesia is required, and narcotics
given concurrently, the dose may need to be lowered.
Reconstitution/Dilution
Ampoule = 5 mg in 1 mL.
IV:
STAT Dose - Medical Staff to be present for administration.
Withdraw 0.2 mL of 5 mg/mL solution and add
to 0.8 mL of water for injection in a second 1 mL syringe = 1 mg/mL.
Withdraw required dose and discard
remaining solution.
IV Infusion:
Withdraw required dose and make up to
ordered fluid volume for infusion.
Suitable infusion fluids include Sodium Chloride
0.9% and Glucose 5% and 10%.
Usual order for infusion will be as follows:
|
Drug
|
How
to make up
|
Dose
equivalent
|
Dose
range
|
|
Midazolam
|
3.0 mg/kg in 50 mL glucose 10%
|
1 mL/hr
= 1 microgram/kg/min
|
0.5 to 2 micrograms/kg/min
|
Route and method of administration
IV:
Given over at least 5 minutes.
Note: Bolus doses are not recommended.
IV Infusion:
Infuse via syringe pump at prescribed rate.
Side effects
Respiratory arrest.
Hypoventilation.
Hypotension may occur if an opiate e.g.
morphine or fentanyl is being used concurrently.
Seizures, agitation or involuntary
movements, including myoclonus, are usually due to improper dosing, rapid
administration or in infants with underlying CNS abnormalities.
Nasal administration may be uncomfortable
because of a burning sensation.
NOTE: Flumazenil can be used for reversal of overdose symptoms.
Special precautions
CAUTION in infants with renal or hepatic dysfunction - dosage adjustment
may be required.
Compatibilities
Glucose 5% and 10%.
Sodium Chloride 0.9%.
Terminal
injection site compatibility (if administered as an
infusion):
Dobutamine, Dopamine,
Adrenaline, Morphine, Potassium Chloride, Insulin.
Incompatibilities
Ampicillin, Ceftazidime, Dexamethasone, Frusemide,
Hydrocortisone, Sodium Bicarbonate.
Midazolam must not be mixed together with: Pentobarbital,
Ranitidine or Phenobarbitone.
Administer alone or contact Pharmacy if
further information is required.
Drug interactions
|
Cimetidine
|
May reduce clearance of Midazolam and therefore
increase effects and possibly lead to toxicity.
|
|
Fentanyl and other opiates
|
May have an additive effective when used with Midazolam,
causing more pronounced sedation and possibly worsening respiratory
depression.
|
|
Theophylline
|
May reduce the effectiveness of Midazolam.
|
Nursing responsibilities
Monitor heart rate and respiratory rate.
Observe chest movement.
Apply pulse oximeter.
Apply transcutaneous CO2 monitor
(if requested by doctor).
Monitor BP.
Change syringe every 24 hours and IV tubing
every 3 days (as per RCH IV Line protocol).
FLUMAZENIL should be available for reversal
of overdose symptoms.
Check that rate of infusion ordered
corresponds with dose required (micrograms/kg/m).