Midazolam in er 1

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Lecture by Prof.Nabil Housin

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Midazolam in er 1

  1. 1. Midazolam Use in theEmergency Department Prof. Med. Nabil H. Mohyeddin Anesthesiologist& Intensivist Board certified Germany, Rostock university
  2. 2. Conscious sedation Minimally depressed level of consciousness Independently and continuously maintain an airway and adequate cardiorespiratory function. Respond to tactile stimulation and/or verbal command. Tolerate the unpleasant procedures.
  3. 3. Conscious sedation )Procedural sedation( in the ED Alleviate anxiety Provide amnesia* Pain : not adequately addressed.
  4. 4. Clinical indications for sedation in the ED Orthopedic reduction.  Chest tube insertion. Cardioversion.  Burn care. Wound debridement.  CT scans and other Pediatric laceration diagnostic procedures in repair. children. Lumbar puncture.  Peritoneal lavage. Abscess incision and  Removal of vaginal or drainage. rectal foreign body.
  5. 5. Drugs for conscious sedation Benzodiazepines: Midazolam Opioids: Fentanyl, Meperidine. Hypnotics agents: Barbiturates, Propofol, Ketamine.
  6. 6. Midazolam Rapid onset. (i.v. 1-3 min, i.m. 5 min) Shorter duration (10-20 min.) No injection pain. Existence of antagonist- Flumazenil
  7. 7. Pharmacology of midazolam  Anxiolytic  Muscle relaxant  Anticonvulsant  Sedative  Hypnotic  Amnesic
  8. 8. 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.
  9. 9. 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.
  10. 10. 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.
  11. 11. Equipment for conscious sedation monitoring  Oxygen and mask.  Pulse oximeter.  ECG monitor.  Suction.  Orotracheal tube.  Laryngoscope.  Ambu bag.
  12. 12. Summary Midazolam: Safe for sedation in ED “Titration”: the principle of administration of midazolam and flumazenil.
  13. 13. 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.
  14. 14. Drug interaction Drugs that inhibit the metabolism of midazolam * Cimetidine * Ranitidine * Omeprazole * Macrolide antibiotics * Oral contraceptives Drug that enhance the metabolism of midazolam * Rifampin

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