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