9. Side effects of midazolam
Respiratory depression
* Short-lived.
* Respond to verbal stimulation and oxygen
alone.
* Injection rate-related. (slowly injection)
Rare:
* Hiccups.
* Cough.
* Nausea/Vomiting.
10. Antagonist )Flumazenil,)Anexate
Reverse hypnotic-sedative effect.
Reverse respiratory depression? (dose)
Overdose: CNS symptoms occurred.
Suggest: Given by incremental dose (0.2 mg)
Short duration of action.
11. Other use of midazolam in the ED
Anticonvulsant:
i.v.: 0.15-0.2 mg/kg 0.75mg/kg/min infusion.
i.m.: 5-15 mg.
Rapid sequence induction (intubation)
Combined with opioids (fentanyl, meperidine):
Respiratory depression, hypoxemia, prolonged
duration.
13. Summary
Midazolam: Safe for sedation in ED
“Titration”: the principle of
administration of midazolam and
flumazenil.
14. NPO for conscious sedation
No evidence-based guideline for optimal fasting
duration prior to sedation in the ED.
ASA recommend: 6 hr for solids.
2 hr for liquids.
Balance between urgency and associated risk.
15. Drug interaction
Drugs that inhibit the metabolism of midazolam
* Cimetidine
* Ranitidine
* Omeprazole
* Macrolide antibiotics
* Oral contraceptives
Drug that enhance the metabolism of midazolam
* Rifampin