Midazolam

CLASS

  • imidazobenzodiazepine

MECHANISM OF ACTION

  • act via benzodiazepine receptor in CNS
  • linked and facilitate action of the GABA receptor.
  • chloride channel activation -> hyperpolarises membrane.
  • also a kappa-opioid agonist -> benzodiazepine induced spinal analgesia.
    1. hypnosis
    2. sedation
    3. anterograde anaesthesia
    4. anxiolysis
    5. anticonvulsant
    6. muscle relaxation

PHARMACEUTICS

  • clear, colourless solution, glass vial

DOSE

  • IV, PR, Intrathecal, Epidural, PO
  • IM – 0.08mg/kg (premed)
  • IV – 0.1mg/kg (sedation) – titrated to response, end point = slurred speech, onset 3min, infusion 0.03-0.2mg/kg/hr
  • Intrathecal – 0.5 to 2mg
  • Epidural – 0.1 to 0.2mg/kg

INDICATIONS

  1. induction of anaesthesia
  2. sedation
  3. pre-medication
  4. treatment of chronic pain

ADVERSE EFFECTS

  • withdrawal effect during prolonged infusion

PHARMACOKINETICS

  • Absorption – bioavailability 40%
  • Distribution – 96% protein bound, Vd 1L/kg
  • Metabolism – hepatic, active metabolites
  • Elimination – urinary, t1/2 = 2.5 hrs

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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