Midazolam Use in theEmergency Department Prof. Med. Nabil H. Mohyeddin Anesthesiologist& Intensivist Board certified Germany, Rostock university
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.
Conscious sedation )Procedural sedation( in the ED Alleviate anxiety Provide amnesia* Pain : not adequately addressed.
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.
Summary Midazolam: Safe for sedation in ED “Titration”: the principle of administration of midazolam and flumazenil.
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.
Drug interaction Drugs that inhibit the metabolism of midazolam * Cimetidine * Ranitidine * Omeprazole * Macrolide antibiotics * Oral contraceptives Drug that enhance the metabolism of midazolam * Rifampin