More common following IV use Respiratory Bronchospasm

coughing, dyspnea, laryngospasm, hyperventilation, shallow respirations, tachypnea, airway obstruction, wheezing, respiratory depression and respiratory arrest when used for conscious sedation. CV: PVCs, big-eminy, bradycardia, tachycardia, va-sovagal episode, nodal rhythm. At injection site: Tenderness, pain, redness, induration, phlebitis.

Drug Interactions Alcohol / T Risk of apnea, airway obstruction, desaturation or hypoventilation

Anesthetics, inhalation / l Dose if midazolam used as an induction agent

CNS Depressants / T Risk of apnea, airway obstruction, desaturation or hypoventilation

Droperidol / T Hypnotic effect of midazolam when used as a premed-ication

Fentanyl / T Hypnotic effect of midazolam when used as a premed-ication

Indinavir / Possible prolonged sedation and respiratory depression Meperidine / See Narcotics; also, T Risk of hypotension

Narcotics / T Hypnotic effect of midazolam when used as premedi-cations

Propofol / T Effect of propofol Ritonavir / Possible prolonged sedation and respiratory depression Thiopental / l Dose if midazolam used as an induction agent How Supplied: Injection: 1 mg/mL, 5 mg/mL

Dosage-

Preoperative sedation, anxiolysis, amnesia.

Adults: 0.07-0.08 mg/kg IM (average: 5 mg) 1 hr before surgery. Children: 0.1-0.15 mg/kg (up to 0.5 mg/kg may be needed for more anxious clients).

Conscious sedation, anxiolysis, amnesia for endoscopic or CV procedures in healthy adults less than 60 years of age.

Using the 1 mg/mL (can be diluted with 0.9% sodium chloride or D5W) product, titrate slowly to the desired effect (usually slurred speech); initial dose should be no higher than 2.5 mg IV (may be as low as 1 mg IV) within a 2-min period, after which an additional 2 min should be waited to evaluate the sedative effect. If additional sedation is necessary, small increments should be given waiting an additional 2 min or more after each increment to evaluate the effect. Total doses greater than 5 mg are usually not required. Children: Dosage must be individualized by the physician.

Conscious sedation for endoscopic or CV procedures in debilitated or chronically ill clients or clients aged 60 or over.

Slowly titrate to the desired effect using no more than 1.5 mg initially IV (may be as little as 1 mg IV) given over a 2-min period after which an additional 2 min or more should be waited to evaluate the effect. If additional sedation is needed, no more than 1 mg should be given over 2

min; wait an additional 2 min or more after each increment in dose. Total doses greater than 3.5 mg are usually not needed.

Induction of general anesthesia, before use of other general anesthetics, in unmedicated clients. Adults, unmedicated clients up to 55 years of age, IV, initial: 0.3-0.35 mg/kg given over 20-30 sec, waiting 2 min for effects to occur. If needed, increments of about 25% of the initial dose can be used to complete induction; or, induction can be completed using a volatile liquid anesthetic. Up to 0.6 mg/kg may be used but recovery will be prolonged. Adults, unmedicated clients over 55 years of age who are good risk surgical clients, initial IV: 0.15-0.3 mg/kg given over 20-30 sec. Adults, unmedicated clients over 55 years of age with severe systemic disease or debilitation, initial IV: 0.15-0.25 mg/kg given over 20-30 sec. Pediatric: 0.05-0.2 mg/kg IV.

Induction of general anesthesia, before use of other general anesthetics, in medicated clients.

Adults, premedicated clients up to 55 years of age, IV, initial: 0.15-0.35 mg/kg. If less than 55 years of age, 0.25 mg/kg may be given over 20-30 sec, allowing 2 min for effect. Adults, premedicat-ed clients over 55 years of age who are good risk surgical clients, initial, IV: 0.2 mg/kg. Adults, premedicated clients over 55 years of age with severe systemic disease or debilitation, initial, IV:

0.15 mg/kg may be sufficient.

Maintenance of balanced anesthesia for short surgical procedures. IV: Incremental injections about 25% of the dose used for induction when signs indicate anesthesia is lightening.

NOTE: Narcotic preanesthetic medication may include fentanyl, 1.5-2 mcg/kg IV 5 min before induction; morphine, up to 0.15 mg/kg IM; meperidine, up to 1 mg/kg IM; or, Innovar, 0.02 mL/kg IM. Sedative

preanesthetic medication may include secobarbital sodium, 200 mg PO or hydroxyzine pamoate, 100 mg PO. Except for fentanyl, all preanes-thetic medications should be given 1 hr prior to midazolam. Doses should always be individualized.

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